Provider Demographics
NPI:1942454004
Name:GAMBINO, DIANA LYNN (MA CCC-SLP,PC)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:LYNN
Last Name:GAMBINO
Suffix:
Gender:F
Credentials:MA CCC-SLP,PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11001-3440
Mailing Address - Country:US
Mailing Address - Phone:917-957-9797
Mailing Address - Fax:
Practice Address - Street 1:60 WILLOW ST
Practice Address - Street 2:
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11001-3440
Practice Address - Country:US
Practice Address - Phone:917-957-9797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-14
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012435235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist