Provider Demographics
NPI:1356611438
Name:QUINTANA, PAULA JEAN
Entity type:Individual
Prefix:MS
First Name:PAULA
Middle Name:JEAN
Last Name:QUINTANA
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:PAULA
Other - Middle Name:JEAN
Other - Last Name:QUINTANA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:2 WOODMONT CT
Mailing Address - Street 2:
Mailing Address - City:HOLTSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11742-2250
Mailing Address - Country:US
Mailing Address - Phone:631-419-6515
Mailing Address - Fax:
Practice Address - Street 1:2 WOODMONT CT
Practice Address - Street 2:
Practice Address - City:HOLTSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11742-2250
Practice Address - Country:US
Practice Address - Phone:631-419-6515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-06
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006116235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist