Provider Demographics
NPI:1215552955
Name:TARDALO, MICHELE (MS SLP-CF, TSSLD)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:
Last Name:TARDALO
Suffix:
Gender:F
Credentials:MS SLP-CF, TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 N LINDEN ST
Mailing Address - Street 2:
Mailing Address - City:N MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-2534
Mailing Address - Country:US
Mailing Address - Phone:516-732-5822
Mailing Address - Fax:
Practice Address - Street 1:285 N LINDEN ST
Practice Address - Street 2:
Practice Address - City:N MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-2534
Practice Address - Country:US
Practice Address - Phone:516-732-5822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-09
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist