Provider Demographics
NPI:1245018019
Name:FAZIO, BRIANNA NOELLE (MS CCC-SLP, TSSLD)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:NOELLE
Last Name:FAZIO
Suffix:
Gender:F
Credentials:MS 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 1:668 RENSSELAER AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-2646
Mailing Address - Country:US
Mailing Address - Phone:347-525-5621
Mailing Address - Fax:
Practice Address - Street 1:15 BEACH ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-2713
Practice Address - Country:US
Practice Address - Phone:718-816-1422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033352235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist