Provider Demographics
NPI:1669626156
Name:MALLORY, DANA ELIZABETH (MS, CCC-SLP, RN, BSN)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:ELIZABETH
Last Name:MALLORY
Suffix:
Gender:F
Credentials:MS, CCC-SLP, RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:258 PELLS RD
Mailing Address - Street 2:
Mailing Address - City:RHINEBECK
Mailing Address - State:NY
Mailing Address - Zip Code:12572-3353
Mailing Address - Country:US
Mailing Address - Phone:516-492-7012
Mailing Address - Fax:
Practice Address - Street 1:258 PELLS RD
Practice Address - Street 2:
Practice Address - City:RHINEBECK
Practice Address - State:NY
Practice Address - Zip Code:12572-3353
Practice Address - Country:US
Practice Address - Phone:516-492-7012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-10
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY607662-1163W00000X
NY013221-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No163W00000XNursing Service ProvidersRegistered Nurse