Provider Demographics
NPI:1801104252
Name:SIBILIO, TINA MARIE (MS)
Entity type:Individual
Prefix:MISS
First Name:TINA
Middle Name:MARIE
Last Name:SIBILIO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7805 19TH DR
Mailing Address - Street 2:APT 2
Mailing Address - City:EAST ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11370-1303
Mailing Address - Country:US
Mailing Address - Phone:718-278-5558
Mailing Address - Fax:
Practice Address - Street 1:7805 19TH DR
Practice Address - Street 2:APT 2
Practice Address - City:EAST ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11370-1303
Practice Address - Country:US
Practice Address - Phone:718-278-5558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-20
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY99978001235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist