Provider Demographics
NPI:1841620614
Name:PAULDING, DEANNA
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:
Last Name:PAULDING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2047 NOSTRAND AVE
Mailing Address - Street 2:APT. 5D
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-2551
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2047 NOSTRAND AVE
Practice Address - Street 2:APT. 5D
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-2551
Practice Address - Country:US
Practice Address - Phone:707-372-7415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-15
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023171235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist