Regina Ann Provisiero, MA/CCC/SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

58017705 Issued in NY

Practice address

220 Windward CT N
Port Jefferson, NY 11777-2323

Phone

(631) 525-7514

NPI assigned

Dec 9, 2008

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

Enrolled in NY

Enrollment records 1

Specialty

Qualified Speech Language Pathologist

Education

Other, 2014

Medicare assignment

May accept Medicare assignment

Group practices

Sensory Solutions of Long Island IncGroup PAC ID 9931579851, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

State licenses

Practice roles

Locations

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.

• Sensory Solutions of Long Island, Inc

  • Speech-Language Pathologist
  • Port Jefferson Station, NY
  • NPI 1700340973
  Medicare reassignment Care Compare group NPD Authorized official
• South Shore Speech Pathology

  • Speech-Language Pathologist
  • Patchogue, NY
  • NPI 1952000887
  NPD Authorized official

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

{
    "created_epoch": "1228780800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1228780800000",
    "number": "1457596207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 WINDWARD CT N",
            "city": "PORT JEFFERSON",
            "state": "NY",
            "postal_code": "117772323",
            "telephone_number": "631-525-7514"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 WINDWARD CT N",
            "city": "PORT JEFFERSON",
            "state": "NY",
            "postal_code": "117772323",
            "telephone_number": "631-525-7514"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROVISIERO",
        "first_name": "REGINA",
        "middle_name": "ANN",
        "name_prefix": "Miss",
        "credential": "MA/CCC/SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-12-09",
        "last_updated": "2008-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NY",
            "license": "58017705",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kyler None Prinz
• Professional Occupational & Physical Therapy, PLLC
• Professional Orthopedic and Sports Physical Therapy, P.C.
• Professional Radiology PC
• Providers R'US LLC
• Alexander Pruden
• Lisamarie Puglisi, DPT
• Jessica L Pumillo, PA-C
• Saad Muhammad Quadri, DO
• Katherine Rosangela Quezada

• Speech-Language Pathologist in Port Jefferson, NY
• Providers in Port Jefferson, 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 Dec 9, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.