Debra Lynn Fennelly, M.S.,CCC/SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

0119701 Issued in NY

Practice address

1014 Grand Blvd
Suite 5
Deer Park, NY 11729-5782

Phone

(631) 243-1764

Fax

(631) 243-3716

NPI assigned

Sep 13, 2010

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Kids First Evaluation and Advocacy Center

  • Local Education Agency (LEA)
  • Deer Park, NY
  • NPI 1376699421
  NPD (past)

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

{
    "created_epoch": "1284336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1284336000000",
    "number": "1134436082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1014 GRAND BLVD",
            "address_2": "SUITE 5",
            "city": "DEER PARK",
            "state": "NY",
            "postal_code": "117295782"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1014 GRAND BLVD",
            "address_2": "SUITE 5",
            "city": "DEER PARK",
            "state": "NY",
            "postal_code": "117295782",
            "telephone_number": "631-243-1764",
            "fax_number": "631-243-3716"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FENNELLY",
        "first_name": "DEBRA",
        "middle_name": "LYNN",
        "name_prefix": "Mrs.",
        "credential": "M.S.,CCC/SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-09-13",
        "last_updated": "2010-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NY",
            "license": "0119701",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Desiree Marie Famighetti
• Family and Children Enrichment Services Inc.
• Christina Fandaros, OTR/L
• Behrouz Farahmandpour, D.O.
• Stephanie Farco, PA
• Vanessa G Fichtner, MS, CCC/SLP
• First Step Custom Interiors Inc
• Jennifer M Fitz
• Formation Health Services LLC
• Melanie Fox, DDS

• Speech-Language Pathologist in Deer Park, NY
• Providers in Deer Park, 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 Sep 13, 2010; 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.