Provider Demographics
NPI:1689828527
Name:CANIZA, AGNES ZORAIDA (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:AGNES
Middle Name:ZORAIDA
Last Name:CANIZA
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:NY
Mailing Address - Zip Code:10962-1304
Mailing Address - Country:US
Mailing Address - Phone:917-553-2798
Mailing Address - Fax:845-613-7372
Practice Address - Street 1:3140B EAST TREMONT AVE.
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-5706
Practice Address - Country:US
Practice Address - Phone:718-239-4147
Practice Address - Fax:718-239-4310
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009802235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist