Provider Demographics
NPI:1366986424
Name:CINQUEMANI, MIRELLA
Entity type:Individual
Prefix:
First Name:MIRELLA
Middle Name:
Last Name:CINQUEMANI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MIRELLA
Other - Middle Name:
Other - Last Name:FERRUCCIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10525 HORACE HARDING EXPY
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-4534
Mailing Address - Country:US
Mailing Address - Phone:718-271-8383
Mailing Address - Fax:
Practice Address - Street 1:10525 HORACE HARDING EXPY
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-4534
Practice Address - Country:US
Practice Address - Phone:718-271-8383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-08
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021214235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist