Provider Demographics
NPI:1639326655
Name:TAVELLA, LINDA EMMA
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:EMMA
Last Name:TAVELLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 BABYLON RD
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-4525
Mailing Address - Country:US
Mailing Address - Phone:516-623-9390
Mailing Address - Fax:
Practice Address - Street 1:16 BABYLON RD
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-4525
Practice Address - Country:US
Practice Address - Phone:516-623-9390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-20
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006500235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist