Provider Demographics
NPI:1801130091
Name:CELENTANO, SANDI KAUSHANSKY (MA CCC SLP)
Entity type:Individual
Prefix:MRS
First Name:SANDI
Middle Name:KAUSHANSKY
Last Name:CELENTANO
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 1:752 ORCHARD LN
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07417-2249
Mailing Address - Country:US
Mailing Address - Phone:201-704-0571
Mailing Address - Fax:
Practice Address - Street 1:752 ORCHARD LN
Practice Address - Street 2:
Practice Address - City:FRANKLIN LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07417-2249
Practice Address - Country:US
Practice Address - Phone:201-704-0571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-12
Last Update Date:2012-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00638900235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist