Individual provider Active NPI

Patricia Cullon Campanelli, M.A.

  • Speech-Language Pathologist
  • Blue Point, NY
National Provider Identifier
1417093741
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
006845-1 Issued in NY
Practice address
235A Blue Point Ave
Blue Point, NY 11715
Phone
(631) 363-5794
Fax
(631) 363-8046
NPI assigned
Jan 30, 2007
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 006845-1 NY Primary

Addresses

Primary practice location

235A Blue Point Ave
Blue Point, NY 11715

Mailing address

3 White Birch Dr
Centereach, NY 11720-3808
Phone (631) 981-1546

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
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
006845-1NYMDSpeech-Language Pathologist

NPI Registry JSON

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

{
    "created_epoch": "1170115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1417093741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 WHITE BIRCH DR",
            "city": "CENTEREACH",
            "state": "NY",
            "postal_code": "117203808",
            "telephone_number": "631-981-1546",
            "fax_number": "631-981-1546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "235A BLUE POINT AVE",
            "city": "BLUE POINT",
            "state": "NY",
            "postal_code": "11715",
            "telephone_number": "631-363-5794",
            "fax_number": "631-363-8046"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAMPANELLI",
        "first_name": "PATRICIA",
        "middle_name": "CULLON",
        "name_prefix": "Mrs.",
        "credential": "M.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NY",
            "license": "006845-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Blue Point, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.