Provider Demographics
NPI:1184449274
Name:BRIONES-PHAN, CELESTE ATIENZA (CCC-SLP, TSSLD)
Entity type:Individual
Prefix:
First Name:CELESTE
Middle Name:ATIENZA
Last Name:BRIONES-PHAN
Suffix:
Gender:F
Credentials:CCC-SLP, TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8279 COUNTRY POINTE CIR
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11427-3003
Mailing Address - Country:US
Mailing Address - Phone:646-407-9352
Mailing Address - Fax:
Practice Address - Street 1:1537 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-8388
Practice Address - Country:US
Practice Address - Phone:718-583-7366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-22
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034901235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist