Individual
ALEXIS FASANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.A., CCC-SLP
Contact information
Practice address
47 JEROME AVE, STATEN ISLAND, NY 10305-3601
(917) 681-6324
Mailing address
47 JEROME AVE, STATEN ISLAND, NY 10305-3601
(917) 681-6324
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
025321-1
NY
Other
Enumeration date
03/31/2016
Last updated
03/31/2016
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