Provider Demographics
NPI:1104135110
Name:KLEMBALLA, SABRINA ANGELA
Entity type:Individual
Prefix:MS
First Name:SABRINA
Middle Name:ANGELA
Last Name:KLEMBALLA
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 1:78 TWIN OAKS DR
Mailing Address - Street 2:
Mailing Address - City:KINGS PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11754-1232
Mailing Address - Country:US
Mailing Address - Phone:631-663-3036
Mailing Address - Fax:
Practice Address - Street 1:78 TWIN OAKS DR
Practice Address - Street 2:
Practice Address - City:KINGS PARK
Practice Address - State:NY
Practice Address - Zip Code:11754-1232
Practice Address - Country:US
Practice Address - Phone:631-663-3036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-26
Last Update Date:2010-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010017-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist