Provider Demographics
NPI:1720690464
Name:MEDINA, ARIANNIE
Entity type:Individual
Prefix:
First Name:ARIANNIE
Middle Name:
Last Name:MEDINA
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 1:52 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTONVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10992-1411
Mailing Address - Country:US
Mailing Address - Phone:845-497-4000
Mailing Address - Fax:
Practice Address - Street 1:52 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WASHINGTONVILLE
Practice Address - State:NY
Practice Address - Zip Code:10992-1411
Practice Address - Country:US
Practice Address - Phone:845-497-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-22
Last Update Date:2024-08-22
Deactivation Date:2024-07-15
Deactivation Code:
Reactivation Date:2024-07-25
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist