Provider Demographics
NPI:1255313797
Name:CAPELLAN-GONZALEZ, CYNTHIA EUNICE (SLP)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:EUNICE
Last Name:CAPELLAN-GONZALEZ
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67-31 161 ST
Mailing Address - Street 2:#5J
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11365
Mailing Address - Country:US
Mailing Address - Phone:917-892-3150
Mailing Address - Fax:
Practice Address - Street 1:1180 REV JAMES A POLITE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10459-2210
Practice Address - Country:US
Practice Address - Phone:718-378-1370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011319235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist