Provider Demographics
NPI:1326381740
Name:MAGGIOLO, TANIA NICOLE
Entity Type:Individual
Prefix:MS
First Name:TANIA
Middle Name:NICOLE
Last Name:MAGGIOLO
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:TANIA
Other - Middle Name:NICOLE
Other - Last Name:WALTERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7 MANCHESTER RD
Mailing Address - Street 2:#2R
Mailing Address - City:EASTCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10709-1301
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7 MANCHESTER RD
Practice Address - Street 2:#2R
Practice Address - City:EASTCHESTER
Practice Address - State:NY
Practice Address - Zip Code:10709-1301
Practice Address - Country:US
Practice Address - Phone:914-793-1891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-03
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015354-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist