Provider Demographics
NPI:1679096432
Name:CISTERNAS, DEANNA ROSE (MA CCC SLP TSSLD)
Entity type:Individual
Prefix:MRS
First Name:DEANNA
Middle Name:ROSE
Last Name:CISTERNAS
Suffix:
Gender:F
Credentials:MA CCC SLP TSSLD
Other - Prefix:MS
Other - First Name:DEANNA
Other - Middle Name:ROSE
Other - Last Name:HUSSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC-SLP, TSSLD
Mailing Address - Street 1:58 WESTWOOD RD S
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11762-1933
Mailing Address - Country:US
Mailing Address - Phone:516-457-3087
Mailing Address - Fax:
Practice Address - Street 1:2351 JERUSALEM AVE
Practice Address - Street 2:
Practice Address - City:NORTH BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-1822
Practice Address - Country:US
Practice Address - Phone:516-608-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-24
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1134888171235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist