Provider Demographics
NPI:1154206316
Name:PELLER, ALEXANDRA (MS CCC-SLP, TSSLD)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:PELLER
Suffix:
Gender:F
Credentials:MS CCC-SLP, TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 E 76TH ST APT 17B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-1415
Mailing Address - Country:US
Mailing Address - Phone:201-400-8202
Mailing Address - Fax:
Practice Address - Street 1:30 E 60TH ST STE 904
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-1059
Practice Address - Country:US
Practice Address - Phone:212-381-8820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-07
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034599-01235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist