Provider Demographics
NPI:1720377849
Name:BELLANTONI, DOREEN MARIE (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DOREEN
Middle Name:MARIE
Last Name:BELLANTONI
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:DOREEN
Other - Middle Name:MARIE
Other - Last Name:DIGANGI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC-SLP
Mailing Address - Street 1:7 WISTERIA WAY
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-2726
Mailing Address - Country:US
Mailing Address - Phone:631-871-5548
Mailing Address - Fax:
Practice Address - Street 1:7 WISTERIA WAY
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-2726
Practice Address - Country:US
Practice Address - Phone:631-871-5548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-29
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020853-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist