Provider Demographics
NPI:1467721365
Name:MALDONADO, TANIA M (CCC,SLP)
Entity Type:Individual
Prefix:MS
First Name:TANIA
Middle Name:M
Last Name:MALDONADO
Suffix:
Gender:F
Credentials:CCC,SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 GIBSON RD
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924-6709
Mailing Address - Country:US
Mailing Address - Phone:845-291-0020
Mailing Address - Fax:
Practice Address - Street 1:53 GIBSON RD
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924-6709
Practice Address - Country:US
Practice Address - Phone:845-291-0020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-21
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016816235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist