Provider Demographics
NPI:1508002114
Name:FAULKNER PITINGARO, SHALYN KELLY (MS CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:SHALYN
Middle Name:KELLY
Last Name:FAULKNER PITINGARO
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 SAGERS FARM RD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-2349
Mailing Address - Country:US
Mailing Address - Phone:845-222-9121
Mailing Address - Fax:
Practice Address - Street 1:11 SAGERS FARM RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:NY
Practice Address - Zip Code:10990-2349
Practice Address - Country:US
Practice Address - Phone:845-222-9121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-02
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016357-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist