Provider Demographics
NPI:1720232887
Name:TELLEZ, CARLA (SLP)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:TELLEZ
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3282 MIDDLETOWN RD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-1041
Mailing Address - Country:US
Mailing Address - Phone:347-739-7172
Mailing Address - Fax:718-829-6667
Practice Address - Street 1:3282 MIDDLETOWN RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-1041
Practice Address - Country:US
Practice Address - Phone:347-739-7172
Practice Address - Fax:718-829-6667
Is Sole Proprietor?:No
Enumeration Date:2008-11-15
Last Update Date:2008-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016236-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist