Provider Demographics
NPI:1346468477
Name:SCAMMELL, ROSE (SLP)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:
Last Name:SCAMMELL
Suffix:
Gender:M
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 GAIL DR
Mailing Address - Street 2:
Mailing Address - City:NORTH MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-1007
Mailing Address - Country:US
Mailing Address - Phone:516-622-8888
Mailing Address - Fax:516-342-2480
Practice Address - Street 1:807 S OYSTER BAY RD
Practice Address - Street 2:
Practice Address - City:BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11714-1030
Practice Address - Country:US
Practice Address - Phone:516-622-8888
Practice Address - Fax:516-342-2480
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008686-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY008686OtherLICENSE