Provider Demographics
NPI:1801032495
Name:D'AGOSTINO, SUSAN M (SPEECH PATHOLOGIST)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:D'AGOSTINO
Suffix:
Gender:F
Credentials:SPEECH PATHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:582 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10603-3221
Mailing Address - Country:US
Mailing Address - Phone:914-573-2387
Mailing Address - Fax:
Practice Address - Street 1:22 GREENTREE DR
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-7014
Practice Address - Country:US
Practice Address - Phone:914-723-1898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-02
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013875-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist