Provider Demographics
NPI:1689986523
Name:PANEPINTO, ERICA (SLP-CCC)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:PANEPINTO
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 DORCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-5402
Mailing Address - Country:US
Mailing Address - Phone:631-258-7923
Mailing Address - Fax:
Practice Address - Street 1:24 DOVECOTE LN
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-2707
Practice Address - Country:US
Practice Address - Phone:631-258-7923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-08
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019923235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist