Provider Demographics
NPI:1548572258
Name:VITALE, SARAH LYN (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:LYN
Last Name:VITALE
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 1:102 S QUAKER LN
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12538-2704
Mailing Address - Country:US
Mailing Address - Phone:845-483-5500
Mailing Address - Fax:845-483-5675
Practice Address - Street 1:110 REHILL AVE
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876-2519
Practice Address - Country:US
Practice Address - Phone:908-685-2946
Practice Address - Fax:908-243-8664
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-10
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019920-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist