Provider Demographics
NPI:1366759672
Name:HERNANDEZ, VIRGINIA-MICHAEL (MA CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:VIRGINIA-MICHAEL
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 MONA DR
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-4160
Mailing Address - Country:US
Mailing Address - Phone:716-835-3476
Mailing Address - Fax:
Practice Address - Street 1:116 MONA DR
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-4160
Practice Address - Country:US
Practice Address - Phone:716-835-3476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-08
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014834-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist