Provider Demographics
NPI:1770638256
Name:MAIZEL-ORISHIMO, STEFANIE T (MA,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:STEFANIE
Middle Name:T
Last Name:MAIZEL-ORISHIMO
Suffix:
Gender:F
Credentials:MA,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11045 71ST RD
Mailing Address - Street 2:3K
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4960
Mailing Address - Country:US
Mailing Address - Phone:516-695-5798
Mailing Address - Fax:
Practice Address - Street 1:74 20 25TH AVE
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11370
Practice Address - Country:US
Practice Address - Phone:718-350-3171
Practice Address - Fax:718-458-1367
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014275235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist