Provider Demographics
NPI:1386888949
Name:SIRI, ILANIT (MA, CCC/SLP)
Entity type:Individual
Prefix:
First Name:ILANIT
Middle Name:
Last Name:SIRI
Suffix:
Gender:F
Credentials:MA, CCC/SLP
Other - Prefix:
Other - First Name:ILANIT
Other - Middle Name:
Other - Last Name:SELA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:43 VALLEY GREENS DR
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581-3634
Mailing Address - Country:US
Mailing Address - Phone:516-458-6914
Mailing Address - Fax:516-295-6969
Practice Address - Street 1:43 VALLEY GREENS DR
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11581-3634
Practice Address - Country:US
Practice Address - Phone:516-458-6914
Practice Address - Fax:516-295-6969
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-27
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009799-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist