Provider Demographics
NPI:1356570196
Name:BRUNO, KRISTIN STACEY (MS)
Entity type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:STACEY
Last Name:BRUNO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 DUNES LN
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-1408
Mailing Address - Country:US
Mailing Address - Phone:516-857-4525
Mailing Address - Fax:
Practice Address - Street 1:8 DUNES LN
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-1408
Practice Address - Country:US
Practice Address - Phone:516-857-4525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-14
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010403-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY09129636OtherASHA