Provider Demographics
NPI:1174067433
Name:SARDELIS, HERMILIA
Entity type:Individual
Prefix:
First Name:HERMILIA
Middle Name:
Last Name:SARDELIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HERMILIA
Other - Middle Name:
Other - Last Name:CIRONE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7002 54TH AVE
Mailing Address - Street 2:
Mailing Address - City:MASPETH
Mailing Address - State:NY
Mailing Address - Zip Code:11378-1745
Mailing Address - Country:US
Mailing Address - Phone:718-639-3817
Mailing Address - Fax:
Practice Address - Street 1:7002 54TH AVE
Practice Address - Street 2:
Practice Address - City:MASPETH
Practice Address - State:NY
Practice Address - Zip Code:11378-1745
Practice Address - Country:US
Practice Address - Phone:718-639-3817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-06
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019563235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist