Provider Demographics
NPI:1144360645
Name:TANTILLO, MARY JANE (MA)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:JANE
Last Name:TANTILLO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3860 TERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18901-5602
Mailing Address - Country:US
Mailing Address - Phone:215-345-4286
Mailing Address - Fax:
Practice Address - Street 1:1650 HUNTINGDON PIKE
Practice Address - Street 2:SUITE 214
Practice Address - City:MEADOWBROOK
Practice Address - State:PA
Practice Address - Zip Code:19046-8004
Practice Address - Country:US
Practice Address - Phone:215-938-8400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT000163L231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist