Provider Demographics
NPI:1598255077
Name:DURAZNO, TRACEY (CCC SLP)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:
Last Name:DURAZNO
Suffix:
Gender:F
Credentials:CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 BEVERLEY RD APT 3F
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-5231
Mailing Address - Country:US
Mailing Address - Phone:347-513-8084
Mailing Address - Fax:
Practice Address - Street 1:610 BALTIC ST RM 227
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-2705
Practice Address - Country:US
Practice Address - Phone:718-398-5470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-10
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027299-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist