Provider Demographics
NPI:1508178906
Name:ROLDAN, ANA TERESA (SLP-CCC)
Entity Type:Individual
Prefix:MRS
First Name:ANA
Middle Name:TERESA
Last Name:ROLDAN
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7404 263RD ST
Mailing Address - Street 2:
Mailing Address - City:GLEN OAKS
Mailing Address - State:NY
Mailing Address - Zip Code:11004-1113
Mailing Address - Country:US
Mailing Address - Phone:718-347-1175
Mailing Address - Fax:
Practice Address - Street 1:185-08 UNION TURPIKE
Practice Address - Street 2:SUITE 101
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11366-1700
Practice Address - Country:US
Practice Address - Phone:718-264-7250
Practice Address - Fax:718-264-7922
Is Sole Proprietor?:No
Enumeration Date:2010-07-14
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019199-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist