Provider Demographics
NPI:1982948642
Name:GIALLORENZO, DANA PATRICIA (MSED)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:PATRICIA
Last Name:GIALLORENZO
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 BRAISTED AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-6172
Mailing Address - Country:US
Mailing Address - Phone:347-461-5607
Mailing Address - Fax:
Practice Address - Street 1:113 BRAISTED AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-6172
Practice Address - Country:US
Practice Address - Phone:347-461-5607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-19
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1413754252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency