Provider Demographics
NPI:1679091581
Name:MENDEZ-NOVOA, GABRIELA KATIA
Entity Type:Individual
Prefix:
First Name:GABRIELA
Middle Name:KATIA
Last Name:MENDEZ-NOVOA
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 1:55 BARROW ST APT 16
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-3795
Mailing Address - Country:US
Mailing Address - Phone:917-608-1706
Mailing Address - Fax:
Practice Address - Street 1:3136 88TH ST
Practice Address - Street 2:
Practice Address - City:EAST ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11369-1415
Practice Address - Country:US
Practice Address - Phone:718-205-1919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-31
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist