Provider Demographics
NPI:1861836561
Name:CAPASELLA, DIANE (SLP)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:
Last Name:CAPASELLA
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4143 43RD ST APT B4
Mailing Address - Street 2:
Mailing Address - City:SUNNYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11104-2501
Mailing Address - Country:US
Mailing Address - Phone:718-361-8854
Mailing Address - Fax:
Practice Address - Street 1:4143 43RD ST APT B4
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11104-2501
Practice Address - Country:US
Practice Address - Phone:718-361-8854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-24
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009098-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist