Provider Demographics
NPI:1770620825
Name:MAZZEO, MICHELE ANN (MA, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:ANN
Last Name:MAZZEO
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 1:241 KILBURN RD S
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-5630
Mailing Address - Country:US
Mailing Address - Phone:516-808-3832
Mailing Address - Fax:
Practice Address - Street 1:241 KILBURN RD S
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-5630
Practice Address - Country:US
Practice Address - Phone:516-808-3832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY105735235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist