Provider Demographics
NPI:1326877937
Name:RELLO, REGINA (CCC-SLP TSSLD)
Entity type:Individual
Prefix:MISS
First Name:REGINA
Middle Name:
Last Name:RELLO
Suffix:
Gender:F
Credentials:CCC-SLP TSSLD
Other - Prefix:MISS
Other - First Name:REGINA
Other - Middle Name:
Other - Last Name:RELLO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CCC-SLP-TSSLD
Mailing Address - Street 1:18 GLOW LN
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-6105
Mailing Address - Country:US
Mailing Address - Phone:516-503-5151
Mailing Address - Fax:
Practice Address - Street 1:714 S 8TH ST
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-5521
Practice Address - Country:US
Practice Address - Phone:631-624-6755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033092-01235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist