Michelle Petraco, M.S.,CCCSLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

0157361 Issued in NY

Practice address

600 Townline Rd
Hauppauge, NY 11788-2837

Phone

(631) 761-8230

NPI assigned

Feb 1, 2007

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

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

{
    "created_epoch": "1170288000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1319587200000",
    "number": "1427196831",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 WASHINGTON PL",
            "city": "MASSAPEQUA",
            "state": "NY",
            "postal_code": "117586323",
            "telephone_number": "516-209-8554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 TOWNLINE RD",
            "city": "HAUPPAUGE",
            "state": "NY",
            "postal_code": "117882837",
            "telephone_number": "631-761-8230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRACO",
        "first_name": "MICHELLE",
        "name_prefix": "Mrs.",
        "credential": "M.S.,CCCSLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-01",
        "last_updated": "2011-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NY",
            "license": "0157361",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Speech-Language Pathologist in Hauppauge, NY
• Providers in Hauppauge, 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 Oct 26, 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.

Verify at the official NPI Registry.