Provider Demographics
NPI:1396193645
Name:FUENTES, BELLKIS SOLANGE (CF-SLP)
Entity Type:Individual
Prefix:
First Name:BELLKIS
Middle Name:SOLANGE
Last Name:FUENTES
Suffix:
Gender:F
Credentials:CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14124 78TH AVE APT 1B
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-3312
Mailing Address - Country:US
Mailing Address - Phone:718-310-9983
Mailing Address - Fax:
Practice Address - Street 1:14124 78TH AVE APT 1B
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-3312
Practice Address - Country:US
Practice Address - Phone:718-310-9983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-27
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist