Provider Demographics
NPI:1669539847
Name:D'AGOSTINO, DAWN R (MA, CCC-A)
Entity type:Individual
Prefix:MS
First Name:DAWN
Middle Name:R
Last Name:D'AGOSTINO
Suffix:
Gender:F
Credentials:MA, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:272 STILL MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:MACEDON
Mailing Address - State:NY
Mailing Address - Zip Code:14502-9363
Mailing Address - Country:US
Mailing Address - Phone:585-388-7496
Mailing Address - Fax:
Practice Address - Street 1:2365 S CLINTON AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-2663
Practice Address - Country:US
Practice Address - Phone:585-758-5700
Practice Address - Fax:585-758-1297
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001028-1231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY160743209Medicaid
NY160743209Medicare UPIN
NY160743209Medicaid
NY160743209Medicare Oscar/Certification