Stephanie Moulketis, MS, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

027806 Issued in NY

Practice address

88 Old Town Rd
Staten Island, NY 10304-4212

Phone

(718) 407-2911

NPI assigned

Jun 17, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Stephanie Moulketis Gajewski Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1560729600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560729600000",
    "number": "1104486620",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "195 ADAMS ST APT 8H",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112011810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "88 OLD TOWN RD",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103044212",
            "telephone_number": "718-407-2911"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "330 Saint Marks Pl",
            "address_purpose": "LOCATION",
            "city": "Staten Island",
            "state": "NY",
            "postal_code": "103012409",
            "country_code": "US",
            "telephone_number": "201-741-6960",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOULKETIS",
        "first_name": "STEPHANIE",
        "credential": "MS, CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-17",
        "last_updated": "2019-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NY",
            "license": "027806",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STEPHANIE",
            "last_name": "MOULKETIS GAJEWSKI",
            "credential": "MS, CCC-SLP",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Soriaya Lizette Motivala, MD, FAANS
• Olga Motorina, ACNP
• Joseph Motta, M.D.
• Tracy Mottley Ellis
• Kathleen A Motto
• Mohamad Bahij Moumneh, MD
• Mount Sinai Medical Center
• Mountainside Diversified
• Omar Mourad, MD
• Asil Mousa

• Speech-Language Pathologist in Staten Island, NY
• Providers in Staten Island, NY by specialty
• Speech-Language Pathologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.