Provider Demographics
NPI:1467713396
Name:FARGIANO, SVETLANA (TSSLD)
Entity Type:Individual
Prefix:MS
First Name:SVETLANA
Middle Name:
Last Name:FARGIANO
Suffix:
Gender:F
Credentials:TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 LONG HILL RD
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:NJ
Mailing Address - Zip Code:07933-1321
Mailing Address - Country:US
Mailing Address - Phone:718-501-7131
Mailing Address - Fax:
Practice Address - Street 1:701 LONG HILL RD
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:NJ
Practice Address - Zip Code:07933-1321
Practice Address - Country:US
Practice Address - Phone:718-501-7131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-07
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
NY323076091235Z00000X
NY792047131174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist