Provider Demographics
NPI:1932241312
Name:DEMILT, MAURA GUINAN (MS CCC SLP)
Entity Type:Individual
Prefix:
First Name:MAURA
Middle Name:GUINAN
Last Name:DEMILT
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 1:2708 WOODS AVE
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-1229
Mailing Address - Country:US
Mailing Address - Phone:516-536-3197
Mailing Address - Fax:516-536-3197
Practice Address - Street 1:2708 WOODS AVE
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-1229
Practice Address - Country:US
Practice Address - Phone:516-536-3197
Practice Address - Fax:516-536-3197
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007780235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist