Provider Demographics
NPI:1679156657
Name:SIROTA, DANIELLE KAYLEIGH (CCC-SLP)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:KAYLEIGH
Last Name:SIROTA
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-3130
Mailing Address - Country:US
Mailing Address - Phone:609-607-7400
Mailing Address - Fax:609-488-5654
Practice Address - Street 1:950 HOOPER AVE STE 2
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-8372
Practice Address - Country:US
Practice Address - Phone:848-251-5355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-28
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS01001800235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist