Provider Demographics
NPI:1386187862
Name:CORONA PADRON, MILDRED (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MILDRED
Middle Name:
Last Name:CORONA PADRON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3005 42ND ST
Mailing Address - Street 2:APT 2L
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-3029
Mailing Address - Country:US
Mailing Address - Phone:646-884-4613
Mailing Address - Fax:
Practice Address - Street 1:628 TINTON AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10455-3218
Practice Address - Country:US
Practice Address - Phone:718-292-5478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-01
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025308235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist