Provider Demographics
NPI:1730201823
Name:VILLANUEVA, CLARE MARIE (AUD)
Entity type:Individual
Prefix:
First Name:CLARE
Middle Name:MARIE
Last Name:VILLANUEVA
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 BRAMSHOTT CT
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-1860
Mailing Address - Country:US
Mailing Address - Phone:917-856-2603
Mailing Address - Fax:516-766-6907
Practice Address - Street 1:934 MANHATTAN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11222-5928
Practice Address - Country:US
Practice Address - Phone:917-856-2703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1764231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04786RMedicare PIN
NYM7407M0132Medicare PIN