Provider Demographics
NPI:1780987545
Name:SORRENTINO, ANDREA ERICA (MA, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:ERICA
Last Name:SORRENTINO
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 ROSSVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-1707
Mailing Address - Country:US
Mailing Address - Phone:407-760-9733
Mailing Address - Fax:
Practice Address - Street 1:777 ROSSVILLE AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10309-1707
Practice Address - Country:US
Practice Address - Phone:407-760-9733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-15
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA10010235Z00000X
NJ41YS00650600235Z00000X
NY022520235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist