Provider Demographics
NPI:1962025163
Name:FERNANDEZ, HALEY ANN (MA, CCC-SLP, TSSLD)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:ANN
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:MA, 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 1:3641 28TH ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-3203
Mailing Address - Country:US
Mailing Address - Phone:718-937-1463
Mailing Address - Fax:
Practice Address - Street 1:3641 28TH ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11106-3203
Practice Address - Country:US
Practice Address - Phone:718-937-1463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-21
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031252235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist