Provider Demographics
NPI:1972880631
Name:ROBLEDO-STAINO, FIDELINA JOANNA (MS, SLP)
Entity Type:Individual
Prefix:MRS
First Name:FIDELINA
Middle Name:JOANNA
Last Name:ROBLEDO-STAINO
Suffix:
Gender:F
Credentials:MS, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 TODDVILLE LN
Mailing Address - Street 2:
Mailing Address - City:CORTLANDT MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10567-4314
Mailing Address - Country:US
Mailing Address - Phone:914-293-7942
Mailing Address - Fax:
Practice Address - Street 1:3634 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:MOHEGAN LAKE
Practice Address - State:NY
Practice Address - Zip Code:10547-1244
Practice Address - Country:US
Practice Address - Phone:914-528-2021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-09
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015248-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist