Provider Demographics
NPI:1649057134
Name:FARIA, YVONNE (SLP, TSSLD, BE)
Entity type:Individual
Prefix:
First Name:YVONNE
Middle Name:
Last Name:FARIA
Suffix:
Gender:F
Credentials:SLP, TSSLD, BE
Other - Prefix:
Other - First Name:YVONNE
Other - Middle Name:M
Other - Last Name:FERNANDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:80 GUION PL APT 11X
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-3840
Mailing Address - Country:US
Mailing Address - Phone:914-426-5275
Mailing Address - Fax:
Practice Address - Street 1:1700 MACOMBS RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-7048
Practice Address - Country:US
Practice Address - Phone:914-426-5275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033196235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist