Provider Demographics
NPI:1356737068
Name:FONSECA, NATHALIA ANDREA (SLPD CCCSLP, TSSLDBE)
Entity type:Individual
Prefix:DR
First Name:NATHALIA
Middle Name:ANDREA
Last Name:FONSECA
Suffix:
Gender:F
Credentials:SLPD CCCSLP, TSSLDBE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8015 LEFFERTS BLVD # 2F
Mailing Address - Street 2:
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-1738
Mailing Address - Country:US
Mailing Address - Phone:718-880-2468
Mailing Address - Fax:347-778-0726
Practice Address - Street 1:8015 LEFFERTS BLVD # 2F
Practice Address - Street 2:
Practice Address - City:KEW GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11415-1738
Practice Address - Country:US
Practice Address - Phone:917-774-3847
Practice Address - Fax:347-778-0726
Is Sole Proprietor?:No
Enumeration Date:2015-04-09
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist