Provider Demographics
NPI:1821557612
Name:RIVERA PAYANO, FELIX E (MACCC-SLP, TSSLD)
Entity Type:Individual
Prefix:
First Name:FELIX
Middle Name:E
Last Name:RIVERA PAYANO
Suffix:
Gender:M
Credentials:MACCC-SLP, TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 CLARENCE AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-1703
Mailing Address - Country:US
Mailing Address - Phone:347-375-7398
Mailing Address - Fax:
Practice Address - Street 1:717 CLARENCE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-1703
Practice Address - Country:US
Practice Address - Phone:347-375-7398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-19
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist