Provider Demographics
NPI:1174066682
Name:ANTIN, JAMIE SABRINA (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:SABRINA
Last Name:ANTIN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2539 BRADLEY CT
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-4335
Mailing Address - Country:US
Mailing Address - Phone:718-378-1626
Mailing Address - Fax:
Practice Address - Street 1:15323 83RD ST
Practice Address - Street 2:
Practice Address - City:HOWARD BEACH
Practice Address - State:NY
Practice Address - Zip Code:11414-1801
Practice Address - Country:US
Practice Address - Phone:718-848-9247
Practice Address - Fax:718-738-8505
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-01
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017009-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist