Provider Demographics
NPI:1558498113
Name:FIELDS, ELYSE CANDICE (MS)
Entity Type:Individual
Prefix:MRS
First Name:ELYSE
Middle Name:CANDICE
Last Name:FIELDS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 BEATRICE LANE
Mailing Address - Street 2:
Mailing Address - City:OLD BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11804
Mailing Address - Country:US
Mailing Address - Phone:516-293-4526
Mailing Address - Fax:
Practice Address - Street 1:32 BEATRICE LN
Practice Address - Street 2:
Practice Address - City:OLD BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11804-1002
Practice Address - Country:US
Practice Address - Phone:516-293-4526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04899-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist