1447495189 NPI number — ANTOINETTE VERONICA, FENOLA MCALLISTER-BLYDEN M.S. CCC-SLP

Table of content: ANTOINETTE VERONICA, FENOLA MCALLISTER-BLYDEN M.S. CCC-SLP (NPI 1447495189)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447495189 NPI number — ANTOINETTE VERONICA, FENOLA MCALLISTER-BLYDEN M.S. CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCALLISTER-BLYDEN
Provider First Name:
ANTOINETTE
Provider Middle Name:
VERONICA, FENOLA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.S. CCC-SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447495189
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/26/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
LANDSTUHL REGIONAL MEDICAL CENTER UNIT 33100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
APO
Provider Business Mailing Address State Name:
AE
Provider Business Mailing Address Postal Code:
09180-3310
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-590-9191
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
LANDSTUHL REGIONAL MEDICAL CENTER UNIT 33100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
APO
Provider Business Practice Location Address State Name:
AE
Provider Business Practice Location Address Postal Code:
09180
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-590-9191
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/09/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: 018238-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 04527928 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".