Provider Demographics
NPI:1174198717
Name:DEL RE, MICHELLE (MS, CF-SLP, TSSLD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:DEL RE
Suffix:
Gender:F
Credentials:MS, CF-SLP, TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 MARTIN RD N
Mailing Address - Street 2:
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714-5119
Mailing Address - Country:US
Mailing Address - Phone:516-642-3675
Mailing Address - Fax:
Practice Address - Street 1:585 STEWART AVE STE 310
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-4701
Practice Address - Country:US
Practice Address - Phone:516-627-3036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist