Provider Demographics
NPI:1578877916
Name:REDINO, MICHELLE ANN (MS CCC NYS LIC SLP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ANN
Last Name:REDINO
Suffix:
Gender:F
Credentials:MS CCC NYS LIC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 LONDERRY LN
Mailing Address - Street 2:
Mailing Address - City:GETZVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14068-1168
Mailing Address - Country:US
Mailing Address - Phone:716-639-0908
Mailing Address - Fax:
Practice Address - Street 1:126 DONALDSON RD
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14208
Practice Address - Country:US
Practice Address - Phone:716-816-3490
Practice Address - Fax:716-888-7109
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-27
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004960-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist