Provider Demographics
NPI:1346856226
Name:FLANNELLY, EILEEN ELIZABETH
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:ELIZABETH
Last Name:FLANNELLY
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 1:33 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-5750
Mailing Address - Country:US
Mailing Address - Phone:516-236-4665
Mailing Address - Fax:
Practice Address - Street 1:33 LOCUST ST
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-5750
Practice Address - Country:US
Practice Address - Phone:516-236-4665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-16
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist