Provider Demographics
NPI:1508173634
Name:FANELLI, MARIA ANN (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:ANN
Last Name:FANELLI
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 WOODBERRY RD
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-2725
Mailing Address - Country:US
Mailing Address - Phone:315-735-0640
Mailing Address - Fax:
Practice Address - Street 1:106 MEMORIAL PKWY
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-4818
Practice Address - Country:US
Practice Address - Phone:315-792-2280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-10
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009282235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist