Provider Demographics
NPI:1609196963
Name:TOMASIELLO, SUSANNA EVE (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SUSANNA
Middle Name:EVE
Last Name:TOMASIELLO
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1581 SW CROSSING CIR
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-2451
Mailing Address - Country:US
Mailing Address - Phone:954-562-1525
Mailing Address - Fax:
Practice Address - Street 1:1581 SW CROSSING CIR
Practice Address - Street 2:
Practice Address - City:PALM CITY
Practice Address - State:FL
Practice Address - Zip Code:34990-2451
Practice Address - Country:US
Practice Address - Phone:954-562-1525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-09
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 7114235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist