Provider Demographics
NPI:1710394127
Name:CALLESANO, DIANA (AUD)
Entity Type:Individual
Prefix:MS
First Name:DIANA
Middle Name:
Last Name:CALLESANO
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 CROSSWAYS PARK DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-2044
Mailing Address - Country:US
Mailing Address - Phone:516-364-0011
Mailing Address - Fax:516-364-0013
Practice Address - Street 1:113 CROSSWAYS PARK DR
Practice Address - Street 2:SUITE 101
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-2044
Practice Address - Country:US
Practice Address - Phone:516-364-0011
Practice Address - Fax:516-364-0013
Is Sole Proprietor?:No
Enumeration Date:2014-07-17
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002531231H00000X
237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter