Provider Demographics
NPI:1982856480
Name:GAMBINO, NANCY A (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:A
Last Name:GAMBINO
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8929 GRIFFON AVE
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14304-4425
Mailing Address - Country:US
Mailing Address - Phone:716-510-4932
Mailing Address - Fax:716-283-9490
Practice Address - Street 1:8929 GRIFFON AVE
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14304-4425
Practice Address - Country:US
Practice Address - Phone:716-510-4932
Practice Address - Fax:716-283-9490
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-15
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004456235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist