Provider Demographics
NPI:1568824316
Name:CUCULLO, BIANCA (MS SLP-CCC)
Entity Type:Individual
Prefix:
First Name:BIANCA
Middle Name:
Last Name:CUCULLO
Suffix:
Gender:F
Credentials:MS SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:937 VINCENT AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-1619
Mailing Address - Country:US
Mailing Address - Phone:718-792-9831
Mailing Address - Fax:
Practice Address - Street 1:937 VINCENT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-1619
Practice Address - Country:US
Practice Address - Phone:718-792-9831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0248831235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist