Provider Demographics
NPI:1083448393
Name:RICCIARDELLI, MADISON
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:RICCIARDELLI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 HEDGEROW LN
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-2711
Mailing Address - Country:US
Mailing Address - Phone:631-388-0066
Mailing Address - Fax:
Practice Address - Street 1:40 FROST MILL RD
Practice Address - Street 2:
Practice Address - City:MILL NECK
Practice Address - State:NY
Practice Address - Zip Code:11765-1102
Practice Address - Country:US
Practice Address - Phone:516-922-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist