Provider Demographics
NPI:1356611511
Name:VETRANO, MAYRA MILAGROS (MS)
Entity type:Individual
Prefix:MRS
First Name:MAYRA
Middle Name:MILAGROS
Last Name:VETRANO
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 1:6220 69TH PL
Mailing Address - Street 2:
Mailing Address - City:MIDDLE VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11379-1108
Mailing Address - Country:US
Mailing Address - Phone:347-617-7887
Mailing Address - Fax:
Practice Address - Street 1:6220 69TH PL
Practice Address - Street 2:
Practice Address - City:MIDDLE VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11379-1108
Practice Address - Country:US
Practice Address - Phone:347-617-7887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-05
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007080235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist