Provider Demographics
NPI:1528204310
Name:MORALESVELAZQUEZ, TANIA B (CCC/SLP/TSHH-BE)
Entity Type:Individual
Prefix:MRS
First Name:TANIA
Middle Name:B
Last Name:MORALESVELAZQUEZ
Suffix:
Gender:F
Credentials:CCC/SLP/TSHH-BE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3946 E TREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-2902
Mailing Address - Country:US
Mailing Address - Phone:917-682-0776
Mailing Address - Fax:
Practice Address - Street 1:1028 E 179TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10460-2222
Practice Address - Country:US
Practice Address - Phone:718-842-0200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-28
Last Update Date:2008-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014341-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist