Provider Demographics
NPI:1245773639
Name:FATA, GERARDINA ELVIRA (MA,CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:GERARDINA
Middle Name:ELVIRA
Last Name:FATA
Suffix:
Gender:F
Credentials:MA,CCC-SLP
Other - Prefix:
Other - First Name:GERARDINA
Other - Middle Name:ELVIRA
Other - Last Name:MANNIELLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA,CCC-SLP
Mailing Address - Street 1:3920 FLATLANDS AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-3512
Mailing Address - Country:US
Mailing Address - Phone:718-421-1682
Mailing Address - Fax:
Practice Address - Street 1:3920 FLATLANDS AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-3512
Practice Address - Country:US
Practice Address - Phone:718-421-1682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-02
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023510235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist