Provider Demographics
NPI:1447380399
Name:DATINO, NANCY L (EDM,AUD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:L
Last Name:DATINO
Suffix:
Gender:F
Credentials:EDM,AUD
Other - Prefix:DR
Other - First Name:NANCY
Other - Middle Name:L
Other - Last Name:DATINO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AUD
Mailing Address - Street 1:323 WAGNER AVE
Mailing Address - Street 2:
Mailing Address - City:MAMARONECK
Mailing Address - State:NY
Mailing Address - Zip Code:10543-2837
Mailing Address - Country:US
Mailing Address - Phone:914-630-0724
Mailing Address - Fax:
Practice Address - Street 1:350 THEODORE FREMD AVE
Practice Address - Street 2:
Practice Address - City:RYE
Practice Address - State:NY
Practice Address - Zip Code:10580-1573
Practice Address - Country:US
Practice Address - Phone:914-588-8088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2013-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000653-1231H00000X
NY007546-1235Z00000X
CT004589235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist