Provider Demographics
NPI:1275120719
Name:MAISONAVE, LYANN MARIE
Entity Type:Individual
Prefix:
First Name:LYANN
Middle Name:MARIE
Last Name:MAISONAVE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7118 68TH PL
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11385-7233
Mailing Address - Country:US
Mailing Address - Phone:646-852-2520
Mailing Address - Fax:
Practice Address - Street 1:2447 EASTCHESTER RD # 2
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-5915
Practice Address - Country:US
Practice Address - Phone:718-882-2111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist