Provider Demographics
NPI:1124819750
Name:DELUCIA, DOMENICO JR
Entity type:Individual
Prefix:
First Name:DOMENICO
Middle Name:
Last Name:DELUCIA
Suffix:JR
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 PROGRESS DR STE 2B
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-6294
Mailing Address - Country:US
Mailing Address - Phone:475-239-5512
Mailing Address - Fax:203-405-1327
Practice Address - Street 1:10 PROGRESS DR STE 2B
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-6294
Practice Address - Country:US
Practice Address - Phone:475-239-5512
Practice Address - Fax:203-405-1327
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-14
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6719235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist