Provider Demographics
NPI:1376861336
Name:CIACCIO SIKIRIC, TINA LISA (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:LISA
Last Name:CIACCIO SIKIRIC
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 ETON RD
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-2047
Mailing Address - Country:US
Mailing Address - Phone:516-850-2133
Mailing Address - Fax:516-358-6272
Practice Address - Street 1:444 COMMUNITY DR
Practice Address - Street 2:SUITE 302
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-3803
Practice Address - Country:US
Practice Address - Phone:516-850-2133
Practice Address - Fax:516-358-6272
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-13
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011429-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist