Provider Demographics
NPI:1265587661
Name:VITELLA, DEBRA ANN (MA CCC SLP)
Entity type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:ANN
Last Name:VITELLA
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 SPRINGMEADOW DR
Mailing Address - Street 2:UNIT B
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-4120
Mailing Address - Country:US
Mailing Address - Phone:631-472-6978
Mailing Address - Fax:
Practice Address - Street 1:215 SPRINGMEADOW DR
Practice Address - Street 2:UNIT B
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741-4120
Practice Address - Country:US
Practice Address - Phone:631-472-6978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY07691-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist