Provider Demographics
NPI:1770134009
Name:COHEN, MANDERLY (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MANDERLY
Middle Name:
Last Name:COHEN
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 1:3 WHITNEY CT
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-6034
Mailing Address - Country:US
Mailing Address - Phone:631-877-5800
Mailing Address - Fax:631-491-5820
Practice Address - Street 1:333 E SHORE RD
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-2924
Practice Address - Country:US
Practice Address - Phone:631-466-5100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-27
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007922235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist