Provider Demographics
NPI:1184187346
Name:AMAYA, GABRIELLA DEE (SLP)
Entity Type:Individual
Prefix:MS
First Name:GABRIELLA
Middle Name:DEE
Last Name:AMAYA
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MS
Other - First Name:GABRIELLA
Other - Middle Name:DEE
Other - Last Name:AMAYA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SLP
Mailing Address - Street 1:2460 LEMOINE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-6231
Mailing Address - Country:US
Mailing Address - Phone:201-500-9657
Mailing Address - Fax:
Practice Address - Street 1:2460 LEMOINE AVE
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-6231
Practice Address - Country:US
Practice Address - Phone:201-500-9657
Practice Address - Fax:201-419-6114
Is Sole Proprietor?:No
Enumeration Date:2019-04-12
Last Update Date:2023-02-02
Deactivation Date:2022-09-29
Deactivation Code:
Reactivation Date:2022-10-18
Provider Licenses
StateLicense IDTaxonomies
NY41YS01148400235Z00000X
NJ41YS01148400235Z00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician