Provider Demographics
NPI:1548578396
Name:O'REILLY, SANDRA A (MA,CCC)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:A
Last Name:O'REILLY
Suffix:
Gender:F
Credentials:MA,CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MIDLAND ST
Mailing Address - Street 2:
Mailing Address - City:COLD SPRING HARBOR
Mailing Address - State:NY
Mailing Address - Zip Code:11724-1826
Mailing Address - Country:US
Mailing Address - Phone:631-367-7930
Mailing Address - Fax:
Practice Address - Street 1:23 GREEN ST STE 204
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-3336
Practice Address - Country:US
Practice Address - Phone:631-427-8430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002252-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist