Provider Demographics
NPI:1134523764
Name:MANFRED, TIANA
Entity type:Individual
Prefix:MS
First Name:TIANA
Middle Name:
Last Name:MANFRED
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 1:25517 KENSINGTON PL
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11020-1054
Mailing Address - Country:US
Mailing Address - Phone:646-641-1461
Mailing Address - Fax:
Practice Address - Street 1:25517 KENSINGTON PL
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11020-1054
Practice Address - Country:US
Practice Address - Phone:646-641-1461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-10
Last Update Date:2017-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist