Provider Demographics
NPI:1245466234
Name:OCASIO, ANDREW (MS,SLP)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:
Last Name:OCASIO
Suffix:
Gender:M
Credentials:MS,SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1695 CRAWFORD RD
Mailing Address - Street 2:
Mailing Address - City:MOHEGAN LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:10547-1602
Mailing Address - Country:US
Mailing Address - Phone:646-372-5041
Mailing Address - Fax:
Practice Address - Street 1:1695 CRAWFORD RD
Practice Address - Street 2:
Practice Address - City:MOHEGAN LAKE
Practice Address - State:NY
Practice Address - Zip Code:10547-1602
Practice Address - Country:US
Practice Address - Phone:646-372-5041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018223235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist