Provider Demographics
NPI:1376370221
Name:DELISCA, DIEUNIFER STERLINE
Entity type:Individual
Prefix:
First Name:DIEUNIFER
Middle Name:STERLINE
Last Name:DELISCA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2436 WEBB AVE APT 1B
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-4803
Mailing Address - Country:US
Mailing Address - Phone:347-583-5545
Mailing Address - Fax:
Practice Address - Street 1:660 FOX ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10455-3505
Practice Address - Country:US
Practice Address - Phone:718-585-1617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034663235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist