Provider Demographics
NPI:1871321869
Name:DOMINGUEZ, GABRIELLA
Entity type:Individual
Prefix:MS
First Name:GABRIELLA
Middle Name:
Last Name:DOMINGUEZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 HAMILTON AVE APT 6F
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-1817
Mailing Address - Country:US
Mailing Address - Phone:917-689-8971
Mailing Address - Fax:
Practice Address - Street 1:6701 20TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-4502
Practice Address - Country:US
Practice Address - Phone:718-236-2380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-23
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
NY035093235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist