Provider Demographics
NPI:1407888100
Name:TALALAY, CARMEN (AUD, CCC-A)
Entity Type:Individual
Prefix:MS
First Name:CARMEN
Middle Name:
Last Name:TALALAY
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 BROADWAY
Mailing Address - Street 2:SUITE 4
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-2715
Mailing Address - Country:US
Mailing Address - Phone:631-789-1794
Mailing Address - Fax:631-789-1867
Practice Address - Street 1:355 BROADWAY
Practice Address - Street 2:SUITE 4
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-2715
Practice Address - Country:US
Practice Address - Phone:631-789-1794
Practice Address - Fax:631-789-1867
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001376-1231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist