Provider Demographics
NPI:1417121351
Name:PELLEGRINO, LINDSAY ANNE (SLP)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:ANNE
Last Name:PELLEGRINO
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:LINDSAY
Other - Middle Name:ANNE
Other - Last Name:CHAMBERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2900 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:NY
Mailing Address - Zip Code:14217-2309
Mailing Address - Country:US
Mailing Address - Phone:716-871-9883
Mailing Address - Fax:716-871-9887
Practice Address - Street 1:2900 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:NY
Practice Address - Zip Code:14217-2309
Practice Address - Country:US
Practice Address - Phone:716-871-9883
Practice Address - Fax:716-871-9887
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-22
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018034-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400066537Medicare PIN