Provider Demographics
NPI:1295069789
Name:CERON, MILDRED VIERA (MS- CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:MILDRED
Middle Name:VIERA
Last Name:CERON
Suffix:
Gender:F
Credentials:MS- CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 MEADOWBROOK RD
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:10533-1203
Mailing Address - Country:US
Mailing Address - Phone:914-591-6785
Mailing Address - Fax:
Practice Address - Street 1:554 FORT WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-2003
Practice Address - Country:US
Practice Address - Phone:212-740-5157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-30
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005636-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist