Provider Demographics
NPI:1134365935
Name:SANTANELLO, MEGAN (SLP)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:SANTANELLO
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:
Other - Last Name:GOODRICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 BLACKMAN ST
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2003
Mailing Address - Country:US
Mailing Address - Phone:631-834-5700
Mailing Address - Fax:
Practice Address - Street 1:5 TEE VIEW CT
Practice Address - Street 2:
Practice Address - City:MANORVILLE
Practice Address - State:NY
Practice Address - Zip Code:11949-2939
Practice Address - Country:US
Practice Address - Phone:631-874-3032
Practice Address - Fax:631-874-4105
Is Sole Proprietor?:No
Enumeration Date:2008-12-29
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018185-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist