Provider Demographics
NPI:1932651064
Name:CASTANIA, ALYSSA LYN (MS-SLP)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:LYN
Last Name:CASTANIA
Suffix:
Gender:F
Credentials:MS-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 RAMBLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10308-2647
Mailing Address - Country:US
Mailing Address - Phone:917-613-8844
Mailing Address - Fax:
Practice Address - Street 1:30 RAMBLEWOOD AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10308-2647
Practice Address - Country:US
Practice Address - Phone:917-613-8844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026217235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist