Provider Demographics
NPI:1700235504
Name:ANGEL DERUVO, MA CCC SLP PLLC
Entity Type:Organization
Organization Name:ANGEL DERUVO, MA CCC SLP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DERUVO
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC SLP
Authorized Official - Phone:917-273-1448
Mailing Address - Street 1:47 CEDAR TER
Mailing Address - Street 2:STATEN ISLAND
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-1701
Mailing Address - Country:US
Mailing Address - Phone:917-273-1448
Mailing Address - Fax:
Practice Address - Street 1:47 CEDAR TER
Practice Address - Street 2:STATEN ISLAND
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-1701
Practice Address - Country:US
Practice Address - Phone:917-273-1448
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-13
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty