Provider Demographics
NPI:1972279008
Name:TRYE, SALLY MI (MA)
Entity Type:Individual
Prefix:MS
First Name:SALLY
Middle Name:MI
Last Name:TRYE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:SALLY
Other - Middle Name:MI
Other - Last Name:TRYE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:50 ALBANY ST # 2
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-5011
Mailing Address - Country:US
Mailing Address - Phone:516-428-5549
Mailing Address - Fax:
Practice Address - Street 1:624 HAWKINS AVE
Practice Address - Street 2:
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-2375
Practice Address - Country:US
Practice Address - Phone:631-240-3579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty