Provider Demographics
NPI:1881007805
Name:QUEZADA, SANEDDY (MA, CCC-SLP TSSLD)
Entity Type:Individual
Prefix:MISS
First Name:SANEDDY
Middle Name:
Last Name:QUEZADA
Suffix:
Gender:F
Credentials:MA, CCC-SLP TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 WINTERS ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10464-1519
Mailing Address - Country:US
Mailing Address - Phone:347-582-4661
Mailing Address - Fax:
Practice Address - Street 1:3050 WEBSTER AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-4901
Practice Address - Country:US
Practice Address - Phone:718-585-2100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-06
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025703235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty