Provider Demographics
NPI:1285878207
Name:AZUMBRADO-SANTAMARIA, MICHELE J (MS-CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:J
Last Name:AZUMBRADO-SANTAMARIA
Suffix:
Gender:F
Credentials:MS-CCC/SLP
Other - Prefix:MRS
Other - First Name:MICHELE
Other - Middle Name:A-
Other - Last Name:SANTAMARIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS-CCC/SLP
Mailing Address - Street 1:1408 E 56TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-4013
Mailing Address - Country:US
Mailing Address - Phone:347-393-4087
Mailing Address - Fax:718-763-8246
Practice Address - Street 1:1408 E 56TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-4013
Practice Address - Country:US
Practice Address - Phone:347-393-4087
Practice Address - Fax:718-763-8246
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-21
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007948-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist