1851846216 NPI number — MRS. PAMELA B TASSIELLO M.A, CCC/SLP

Table of content: MRS. PAMELA B TASSIELLO M.A, CCC/SLP (NPI 1851846216)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851846216 NPI number — MRS. PAMELA B TASSIELLO M.A, CCC/SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TASSIELLO
Provider First Name:
PAMELA
Provider Middle Name:
B
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.A, CCC/SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KALISH
Provider Other First Name:
PAMELA
Provider Other Middle Name:
B
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.A., CCC/SLP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1851846216
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/15/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11 HEDGE MEADOW LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWTOWN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06470-1320
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-803-0561
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11 HEDGE MEADOW LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWTOWN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06470-1320
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-803-0561
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/15/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  03-354204 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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