Provider Demographics
NPI:1396054383
Name:SANGINARIO-VICTOR, JEANNE MARIE
Entity type:Individual
Prefix:MRS
First Name:JEANNE
Middle Name:MARIE
Last Name:SANGINARIO-VICTOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 W PARK DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-2417
Mailing Address - Country:US
Mailing Address - Phone:631-385-1942
Mailing Address - Fax:
Practice Address - Street 1:201 SUNRISE HWY
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-1868
Practice Address - Country:US
Practice Address - Phone:631-244-5950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-25
Last Update Date:2010-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003879-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist