Provider Demographics
NPI:1639255649
Name:MAZZONE, TARA LEE (AUD)
Entity Type:Individual
Prefix:MS
First Name:TARA
Middle Name:LEE
Last Name:MAZZONE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SCHWAB ROAD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-1130
Mailing Address - Country:US
Mailing Address - Phone:631-271-1018
Mailing Address - Fax:631-271-1782
Practice Address - Street 1:1 SCHWAB ROAD
Practice Address - Street 2:SUITE 3
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-1130
Practice Address - Country:US
Practice Address - Phone:631-271-1018
Practice Address - Fax:631-271-1782
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1824-01231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist