Provider Demographics
NPI:1780770172
Name:BORRELLI, BRIANNA R (MA)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:R
Last Name:BORRELLI
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:BRIANNA
Other - Middle Name:R
Other - Last Name:HARDIMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:71 LYELL AVE
Mailing Address - Street 2:
Mailing Address - City:SPENCERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14559-1899
Mailing Address - Country:US
Mailing Address - Phone:585-349-5455
Mailing Address - Fax:
Practice Address - Street 1:71 LYELL AVE
Practice Address - Street 2:
Practice Address - City:SPENCERPORT
Practice Address - State:NY
Practice Address - Zip Code:14559-1899
Practice Address - Country:US
Practice Address - Phone:585-349-5455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016307-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY30-0213081Medicaid
NY30-0213081OtherTAX ID