Provider Demographics
NPI:1891064903
Name:MORALES LOSITO, WANDA (MA/SLP)
Entity Type:Individual
Prefix:MRS
First Name:WANDA
Middle Name:
Last Name:MORALES LOSITO
Suffix:
Gender:F
Credentials:MA/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 DOROTHY ST
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-1723
Mailing Address - Country:US
Mailing Address - Phone:631-828-6708
Mailing Address - Fax:
Practice Address - Street 1:7 DOROTHY ST
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-1723
Practice Address - Country:US
Practice Address - Phone:631-828-6708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004773235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist