Basic Information
| Provider Information | |||||||||
| NPI: | 1528203031 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AQUILINA-FIDUCCIA | ||||||||
| FirstName: | JACQUELINE | ||||||||
| MiddleName: | ROSE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | M.A. CCC/SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 360 HOWARD AVE | ||||||||
| Address2: | |||||||||
| City: | FRANKLIN SQUARE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 110103341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5162922711 | ||||||||
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| Practice Location | |||||||||
| Address1: | 47 HUMPHREY DR | ||||||||
| Address2: | |||||||||
| City: | SYOSSET | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117914022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5169217171 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2008 | ||||||||
| LastUpdateDate: | 12/11/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 018014-1 | NY | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.