Provider Demographics
NPI:1275743239
Name:PADULA, THERESA CANNIZZARO (SLP)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:CANNIZZARO
Last Name:PADULA
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 1:54 FLORENCE PL
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-3613
Mailing Address - Country:US
Mailing Address - Phone:718-967-2827
Mailing Address - Fax:
Practice Address - Street 1:122 E 23RD ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-4516
Practice Address - Country:US
Practice Address - Phone:212-677-7400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008891235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist