Basic Information
| Provider Information | |||||||||
| NPI: | 1013548007 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PANEPINTO | ||||||||
| FirstName: | CHRISTINA | ||||||||
| MiddleName: | NICHOLE | ||||||||
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| Credential: | M.A. C.F.-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15 WAGON LN | ||||||||
| Address2: | |||||||||
| City: | GLEN HEAD | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115451943 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6466755961 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 15-50 14TH ROAD | ||||||||
| Address2: | |||||||||
| City: | WHITESTONE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11357 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187670071 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2020 | ||||||||
| LastUpdateDate: | 09/30/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/30/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.