Provider Demographics
NPI:1255321964
Name:DE FINO, SANDRA SUE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:SUE
Last Name:DE FINO
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:SUE
Other - Last Name:PARSONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1219 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-2646
Mailing Address - Country:US
Mailing Address - Phone:570-421-2232
Mailing Address - Fax:570-421-1825
Practice Address - Street 1:1219 N 5TH ST
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-2646
Practice Address - Country:US
Practice Address - Phone:570-421-2232
Practice Address - Fax:570-421-1825
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL004836L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018260500003Medicaid