Provider Demographics
NPI:1669612370
Name:POMILLA, DONNA M (MA, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:DONNA
Middle Name:M
Last Name:POMILLA
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 COMMACK RD APT 20
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11729-5518
Mailing Address - Country:US
Mailing Address - Phone:631-667-3665
Mailing Address - Fax:
Practice Address - Street 1:10 JAMES ST
Practice Address - Street 2:
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-2808
Practice Address - Country:US
Practice Address - Phone:631-669-8255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-20
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist