Active NPI
Pamela Konstantina Petrushesky, SLP
- Speech-Language Pathologist
- East Pembroke, NY
National Provider Identifier
1275810327
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 005729-1
- Practice address
- 2486 Main Rd
East Pembroke, NY 14056 - Phone
- (585) 599-4525
- NPI assigned
- Nov 3, 2011
- Last updated
- Nov 3, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 005729-1 | NY | Primary |
Addresses
Primary practice location
2486 Main Rd
East Pembroke, NY 14056
Mailing address
34 Running Brook Dr
Lancaster, NY 14086-3309
Phone (716) 668-5756
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 005729-1 | NY | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1320278400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1320278400000",
"number": "1275810327",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "34 RUNNING BROOK DR",
"city": "LANCASTER",
"state": "NY",
"postal_code": "140863309",
"telephone_number": "716-668-5756"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2486 MAIN RD",
"city": "EAST PEMBROKE",
"state": "NY",
"postal_code": "14056",
"telephone_number": "585-599-4525"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETRUSHESKY",
"first_name": "PAMELA",
"middle_name": "KONSTANTINA",
"name_prefix": "Mrs.",
"credential": "SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-11-03",
"last_updated": "2011-11-03",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "NY",
"license": "005729-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in East Pembroke, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.