Provider Demographics
NPI:1457752727
Name:ACQUISTA, TANYA LEE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:LEE
Last Name:ACQUISTA
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:MISS
Other - First Name:TANYA
Other - Middle Name:LEE
Other - Last Name:VENTURINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:187-30 GRAND CENTRAL PARKWAY
Mailing Address - Street 2:
Mailing Address - City:JAMAICA ESTATES
Mailing Address - State:NY
Mailing Address - Zip Code:11432
Mailing Address - Country:US
Mailing Address - Phone:718-264-2931
Mailing Address - Fax:
Practice Address - Street 1:187-30 GRAND CENTRAL PARKWAY
Practice Address - Street 2:
Practice Address - City:JAMAICA ESTATES
Practice Address - State:NY
Practice Address - Zip Code:11432
Practice Address - Country:US
Practice Address - Phone:718-264-2931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-05
Last Update Date:2017-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023504-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist