Provider Demographics
NPI:1619753639
Name:JOSEPH, DEANDRA ABRIELL (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DEANDRA
Middle Name:ABRIELL
Last Name:JOSEPH
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 1:13529 220TH PL
Mailing Address - Street 2:
Mailing Address - City:LAURELTON
Mailing Address - State:NY
Mailing Address - Zip Code:11413-1939
Mailing Address - Country:US
Mailing Address - Phone:917-691-6834
Mailing Address - Fax:
Practice Address - Street 1:5015 44TH ST
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-7319
Practice Address - Country:US
Practice Address - Phone:718-361-3567
Practice Address - Fax:718-361-3568
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-05
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032886-01235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist