Provider Demographics
NPI:1841582194
Name:TYLIPAKIS, SANDRA (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:
Last Name:TYLIPAKIS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24427 61ST AVE
Mailing Address - Street 2:
Mailing Address - City:DOUGLASTON
Mailing Address - State:NY
Mailing Address - Zip Code:11362-1934
Mailing Address - Country:US
Mailing Address - Phone:718-428-9460
Mailing Address - Fax:
Practice Address - Street 1:24427 61ST AVE
Practice Address - Street 2:
Practice Address - City:DOUGLASTON
Practice Address - State:NY
Practice Address - Zip Code:11362-1934
Practice Address - Country:US
Practice Address - Phone:718-428-9460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-04
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020084-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist