Provider Demographics
NPI:1922309954
Name:GATZOFLIAS, ATHANASIA NANCY (MA CCC-SLP TSHH)
Entity Type:Individual
Prefix:MRS
First Name:ATHANASIA NANCY
Middle Name:
Last Name:GATZOFLIAS
Suffix:
Gender:F
Credentials:MA CCC-SLP TSHH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MEMORIAL PL
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-2320
Mailing Address - Country:US
Mailing Address - Phone:516-267-7400
Mailing Address - Fax:
Practice Address - Street 1:200 MEMORIAL PL
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-2320
Practice Address - Country:US
Practice Address - Phone:516-267-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-08
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009780-01235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist