Provider Demographics
NPI:1306142039
Name:BUSCAGLIA, DEIDRE ELIZABETH
Entity type:Individual
Prefix:MRS
First Name:DEIDRE
Middle Name:ELIZABETH
Last Name:BUSCAGLIA
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:DEIDRE
Other - Middle Name:ELIZABETH
Other - Last Name:SLOWINSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:67 SOUTHWIND TRL
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-2237
Mailing Address - Country:US
Mailing Address - Phone:716-689-6147
Mailing Address - Fax:
Practice Address - Street 1:67 SOUTHWIND TRL
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-2237
Practice Address - Country:US
Practice Address - Phone:716-689-6147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-27
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00247235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01002948OtherASHA CERTIFICATION SPEECH PATHOLOGY
NY00247OtherNEW YORK STATE LICENSE SPEECH PATHOLOGY