Provider Demographics
NPI:1982859161
Name:NARDO, MARISA DANIELLE (MACCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARISA
Middle Name:DANIELLE
Last Name:NARDO
Suffix:
Gender:F
Credentials:MACCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1823 ROBERTA LN
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-2854
Mailing Address - Country:US
Mailing Address - Phone:516-378-0468
Mailing Address - Fax:
Practice Address - Street 1:346 AVENUE P
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-3518
Practice Address - Country:US
Practice Address - Phone:718-375-9506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-01
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017659-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist