Provider Demographics
NPI:1245818905
Name:PANTELATOS, GEORGIA (MS, CCC-SLP, TSSLD)
Entity type:Individual
Prefix:
First Name:GEORGIA
Middle Name:
Last Name:PANTELATOS
Suffix:
Gender:F
Credentials:MS, CCC-SLP, TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17118 BAGLEY AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-3824
Mailing Address - Country:US
Mailing Address - Phone:347-461-0172
Mailing Address - Fax:
Practice Address - Street 1:222 W 134TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10030-3002
Practice Address - Country:US
Practice Address - Phone:212-690-5915
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-01
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030577235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist