Provider Demographics
NPI:1578999272
Name:PISANIELLO, JOAN M (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:M
Last Name:PISANIELLO
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5111 PALMER RANCH PKWY
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34238-4477
Mailing Address - Country:US
Mailing Address - Phone:941-441-2914
Mailing Address - Fax:
Practice Address - Street 1:5111 PALMER RANCH PKWY
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34238-4477
Practice Address - Country:US
Practice Address - Phone:941-441-2914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-25
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA5199235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist