Provider Demographics
NPI:1265718357
Name:AMELIO, MARLANE A (MA, CCC SLP)
Entity type:Individual
Prefix:
First Name:MARLANE
Middle Name:A
Last Name:AMELIO
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 1:100 OLD WELL RD
Mailing Address - Street 2:
Mailing Address - City:PURCHASE
Mailing Address - State:NY
Mailing Address - Zip Code:10577-1513
Mailing Address - Country:US
Mailing Address - Phone:914-393-5033
Mailing Address - Fax:
Practice Address - Street 1:100 OLD WELL RD
Practice Address - Street 2:
Practice Address - City:PURCHASE
Practice Address - State:NY
Practice Address - Zip Code:10577-1513
Practice Address - Country:US
Practice Address - Phone:914-393-5033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-02
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007324235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist