Provider Demographics
NPI:1255884821
Name:MERENDINO, BRIANNA MARIE (MS, CCC-SLP, TSSLD)
Entity type:Individual
Prefix:MRS
First Name:BRIANNA
Middle Name:MARIE
Last Name:MERENDINO
Suffix:
Gender:F
Credentials:MS, CCC-SLP, TSSLD
Other - Prefix:MISS
Other - First Name:BRIANNA
Other - Middle Name:MARIE
Other - Last Name:MALDONADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP, TSSLD
Mailing Address - Street 1:7 ROUND HOUSE RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:10506-2210
Mailing Address - Country:US
Mailing Address - Phone:914-804-4305
Mailing Address - Fax:
Practice Address - Street 1:750 BAYCHESTER AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-1701
Practice Address - Country:US
Practice Address - Phone:718-904-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-29
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025882235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04458917Medicaid