Provider Demographics
NPI:1639068372
Name:PENAGOS, GABRIELA ANDREA
Entity type:Individual
Prefix:
First Name:GABRIELA
Middle Name:ANDREA
Last Name:PENAGOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:274 BOLTON RD
Mailing Address - Street 2:
Mailing Address - City:EAST WINDSOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08520-5504
Mailing Address - Country:US
Mailing Address - Phone:609-488-0538
Mailing Address - Fax:
Practice Address - Street 1:274 BOLTON RD
Practice Address - Street 2:
Practice Address - City:EAST WINDSOR
Practice Address - State:NJ
Practice Address - Zip Code:08520-5504
Practice Address - Country:US
Practice Address - Phone:609-488-0538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-30
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist