Provider Demographics
NPI:1871720953
Name:GALLO, PAMELA DAWN (MS)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:DAWN
Last Name:GALLO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5350 WILLOW LAKE DR
Mailing Address - Street 2:
Mailing Address - City:CLARENCE
Mailing Address - State:NY
Mailing Address - Zip Code:14031-1228
Mailing Address - Country:US
Mailing Address - Phone:716-741-2492
Mailing Address - Fax:
Practice Address - Street 1:5350 WILLOW LAKE DR
Practice Address - Street 2:
Practice Address - City:CLARENCE
Practice Address - State:NY
Practice Address - Zip Code:14031-1228
Practice Address - Country:US
Practice Address - Phone:716-741-2492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-16
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006689-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist