Individual
CANDICE CEPEDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
118 SPRING ST, PORT JEFFERSON, NY 11777-1817
(631) 476-0564
Mailing address
118 SPRING ST, PORT JEFFERSON, NY 11777-1817
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
024934-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
024934-1
NEW YORK STATE SPEECH LANGUAGE PATHOLOGIST LICENSE
NY
Enumeration date
08/27/2014
Last updated
11/27/2019
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