Provider Demographics
NPI:1689829046
Name:URSI, FABIANA ANDREA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:FABIANA
Middle Name:ANDREA
Last Name:URSI
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-1915
Mailing Address - Country:US
Mailing Address - Phone:631-877-8912
Mailing Address - Fax:
Practice Address - Street 1:9801 25TH AVE
Practice Address - Street 2:
Practice Address - City:EAST ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11369-1639
Practice Address - Country:US
Practice Address - Phone:718-446-4700
Practice Address - Fax:718-397-7645
Is Sole Proprietor?:No
Enumeration Date:2008-11-25
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017307-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist