Provider Demographics
NPI:1598034985
Name:SEMENTILLI, ANGELA (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:
Last Name:SEMENTILLI
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:MS
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:GABRIELE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC-SLP
Mailing Address - Street 1:45 TALLMADGE TRL
Mailing Address - Street 2:
Mailing Address - City:MILLER PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11764-2327
Mailing Address - Country:US
Mailing Address - Phone:631-828-1750
Mailing Address - Fax:
Practice Address - Street 1:380 OLD TOWN RD
Practice Address - Street 2:
Practice Address - City:SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-3482
Practice Address - Country:US
Practice Address - Phone:631-730-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-14
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006393235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY11-2116435Medicaid