Provider Demographics
NPI:1689094906
Name:JABAILY, DIANNA MARIE (MA, CCC-SLP, TSSLD)
Entity Type:Individual
Prefix:
First Name:DIANNA
Middle Name:MARIE
Last Name:JABAILY
Suffix:
Gender:F
Credentials:MA, CCC-SLP, TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 HENDERSON AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-2107
Mailing Address - Country:US
Mailing Address - Phone:718-816-8897
Mailing Address - Fax:
Practice Address - Street 1:91 HENDERSON AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-2107
Practice Address - Country:US
Practice Address - Phone:718-816-8897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-25
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025296235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist