Provider Demographics
NPI:1063955870
Name:BRIONES, STEPHANIE (MA, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:
Last Name:BRIONES
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4217 213TH ST
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-2854
Mailing Address - Country:US
Mailing Address - Phone:347-840-0118
Mailing Address - Fax:
Practice Address - Street 1:9802 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-2128
Practice Address - Country:US
Practice Address - Phone:718-424-5859
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-28
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY58025044235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist