Provider Demographics
NPI:1376079012
Name:IAVARONE, ANTONIA (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ANTONIA
Middle Name:
Last Name:IAVARONE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:ANTONIA
Other - Middle Name:
Other - Last Name:SKOUFIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:3 ERICK CT
Mailing Address - Street 2:
Mailing Address - City:COLD SPRING HARBOR
Mailing Address - State:NY
Mailing Address - Zip Code:11724-1915
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15 LUCILLE DR
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-3725
Practice Address - Country:US
Practice Address - Phone:516-816-6383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-01
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY026975235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program