Provider Demographics
NPI:1376684324
Name:ANTONUCCI, CHERYL (MA, CCC-SP, LSLP)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:
Last Name:ANTONUCCI
Suffix:
Gender:F
Credentials:MA, CCC-SP, LSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 WILLIAM PENN DR
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-1318
Mailing Address - Country:US
Mailing Address - Phone:631-689-5737
Mailing Address - Fax:
Practice Address - Street 1:2 WILLIAM PENN DR
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-1318
Practice Address - Country:US
Practice Address - Phone:631-689-5737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-11
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005850-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist