Provider Demographics
NPI:1972162378
Name:IASELLO, SABRINA MARIE
Entity Type:Individual
Prefix:
First Name:SABRINA
Middle Name:MARIE
Last Name:IASELLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 LOCUST AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-2931
Mailing Address - Country:US
Mailing Address - Phone:516-680-0958
Mailing Address - Fax:
Practice Address - Street 1:1201 66TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-5914
Practice Address - Country:US
Practice Address - Phone:718-259-4389
Practice Address - Fax:718-259-4218
Is Sole Proprietor?:No
Enumeration Date:2019-06-10
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist