Basic Information
Provider Information
NPI: 1003292996
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SCANNELL
FirstName: LINDSEY
MiddleName:  
NamePrefix: MS.
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: SCANNELL
OtherFirstName: LINDSEY
OtherMiddleName: BROOKE
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: 42 STATE PL
Address2:  
City: HUNTINGTON
State: NY
PostalCode: 117435633
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 42 STATE PL
Address2:  
City: HUNTINGTON
State: NY
PostalCode: 117435633
CountryCode: US
TelephoneNumber: 6314700909
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/03/2015
LastUpdateDate: 08/03/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
222Q00000X384049101NYN Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist 
222Q00000X383710101NYN Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist 
222Q00000X592922121NYY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist 

No ID Information.


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