Provider Demographics
NPI:1295153252
Name:FAPPIANO, MARISSA ANN (MS SLP-CCC)
Entity type:Individual
Prefix:MS
First Name:MARISSA
Middle Name:ANN
Last Name:FAPPIANO
Suffix:
Gender:F
Credentials:MS SLP-CCC
Other - Prefix:MRS
Other - First Name:MARISSA
Other - Middle Name:ANN
Other - Last Name:AIANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:798 PELTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10310-3154
Mailing Address - Country:US
Mailing Address - Phone:917-836-8964
Mailing Address - Fax:
Practice Address - Street 1:798 PELTON AVENUE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10310-3154
Practice Address - Country:US
Practice Address - Phone:917-836-8964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-06
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY58023648235Z00000X
2355S0801X
NY023648-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
No174400000XOther Service ProvidersSpecialist