Provider Demographics
NPI:1952836397
Name:DAQUILA, ALEXANDRA G (MS CCC-SLP, TSSLD)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:G
Last Name:DAQUILA
Suffix:
Gender:F
Credentials:MS CCC-SLP, TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:281 THOMAS ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-1703
Mailing Address - Country:US
Mailing Address - Phone:917-863-8317
Mailing Address - Fax:
Practice Address - Street 1:281 THOMAS ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-1703
Practice Address - Country:US
Practice Address - Phone:917-863-8317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-24
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026618-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist