Provider Demographics
NPI:1952638876
Name:GILLETTE, DINA MARIE (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DINA
Middle Name:MARIE
Last Name:GILLETTE
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:DINA
Other - Middle Name:MARIE
Other - Last Name:DANZI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA CCC-SLP
Mailing Address - Street 1:33 TENNYSON DRIVE
Mailing Address - Street 2:
Mailing Address - City:NANUIT
Mailing Address - State:NY
Mailing Address - Zip Code:10954
Mailing Address - Country:US
Mailing Address - Phone:917-647-4134
Mailing Address - Fax:
Practice Address - Street 1:1225 FRANKLIN AVENUE
Practice Address - Street 2:SUITE 325
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530
Practice Address - Country:US
Practice Address - Phone:516-746-2609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-13
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011948235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist