Provider Demographics
NPI:1497989693
Name:IANNUZZI, MICHELLE (MA CCC SLP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:IANNUZZI
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3282 MIDDLETOWN RD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-1041
Mailing Address - Country:US
Mailing Address - Phone:718-801-3493
Mailing Address - Fax:
Practice Address - Street 1:3036 E TREMONT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-5733
Practice Address - Country:US
Practice Address - Phone:718-823-3191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-04
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017519-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist