Provider Demographics
NPI:1396891453
Name:SANFILIPPO, MARY ANN (SLP-CCC)
Entity type:Individual
Prefix:MRS
First Name:MARY ANN
Middle Name:
Last Name:SANFILIPPO
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:MARY ANN
Other - Middle Name:
Other - Last Name:CAPOZZI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:15 S ELM ST
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-4362
Mailing Address - Country:US
Mailing Address - Phone:516-937-0344
Mailing Address - Fax:
Practice Address - Street 1:15 S ELM ST
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-4362
Practice Address - Country:US
Practice Address - Phone:516-937-0344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007111235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist