Provider Demographics
NPI:1841908332
Name:LANE, DARIENA ZULEIKA (SLP-CCC)
Entity type:Individual
Prefix:
First Name:DARIENA
Middle Name:ZULEIKA
Last Name:LANE
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 N CAMBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:MALVERNE
Mailing Address - State:NY
Mailing Address - Zip Code:11565-2205
Mailing Address - Country:US
Mailing Address - Phone:321-261-1605
Mailing Address - Fax:
Practice Address - Street 1:17 N CAMBRIDGE ST
Practice Address - Street 2:
Practice Address - City:MALVERNE
Practice Address - State:NY
Practice Address - Zip Code:11565-2205
Practice Address - Country:US
Practice Address - Phone:321-261-1605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031574-01235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty