Provider Demographics
NPI:1417093741
Name:CAMPANELLI, PATRICIA CULLON (MA)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:CULLON
Last Name:CAMPANELLI
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 WHITE BIRCH DR
Mailing Address - Street 2:
Mailing Address - City:CENTEREACH
Mailing Address - State:NY
Mailing Address - Zip Code:11720-3808
Mailing Address - Country:US
Mailing Address - Phone:631-981-1546
Mailing Address - Fax:631-981-1546
Practice Address - Street 1:235A BLUE POINT AVE
Practice Address - Street 2:
Practice Address - City:BLUE POINT
Practice Address - State:NY
Practice Address - Zip Code:11715
Practice Address - Country:US
Practice Address - Phone:631-363-5794
Practice Address - Fax:631-363-8046
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006845-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist