Provider Demographics
NPI:1851582175
Name:DERUVO, ANGEL (SLP MA CCC)
Entity Type:Individual
Prefix:MS
First Name:ANGEL
Middle Name:
Last Name:DERUVO
Suffix:
Gender:F
Credentials:SLP MA CCC
Other - Prefix:MRS
Other - First Name:ANGEL
Other - Middle Name:
Other - Last Name:DERUVO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SLP MA CCC
Mailing Address - Street 1:47 CEDAR TERRACE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304
Mailing Address - Country:US
Mailing Address - Phone:817-273-1448
Mailing Address - Fax:718-442-7641
Practice Address - Street 1:47 CEDAR TERRACE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304
Practice Address - Country:US
Practice Address - Phone:817-273-1448
Practice Address - Fax:718-442-7641
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY58014493235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist