Provider Demographics
NPI:1063930378
Name:DECK, AMANDA PAIGE (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:PAIGE
Last Name:DECK
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 1:164 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOLTSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11742-2310
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:213 HALLOCK ROAD
Practice Address - Street 2:STE 6
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-3000
Practice Address - Country:US
Practice Address - Phone:631-689-6858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-07
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0267381235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist