Provider Demographics
NPI:1548928682
Name:VANDERPOOL, AYALA
Entity type:Individual
Prefix:
First Name:AYALA
Middle Name:
Last Name:VANDERPOOL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AYALA
Other - Middle Name:
Other - Last Name:VANDERPOOL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, CCC-SLP TSSLD
Mailing Address - Street 1:179 EVELYN RD
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-3207
Mailing Address - Country:US
Mailing Address - Phone:516-761-0684
Mailing Address - Fax:
Practice Address - Street 1:72 FARMEDGE RD
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:NY
Practice Address - Zip Code:11756-5202
Practice Address - Country:US
Practice Address - Phone:516-490-3301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-06
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033036235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist