Provider Demographics
NPI:1871804195
Name:LLERAS, REGINA (MS CCC-SLP TSSLD)
Entity type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:
Last Name:LLERAS
Suffix:
Gender:F
Credentials:MS CCC-SLP TSSLD
Other - Prefix:MISS
Other - First Name:REGINA
Other - Middle Name:
Other - Last Name:STRONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP TSSLD
Mailing Address - Street 1:5225 NESCONSET HWY
Mailing Address - Street 2:SUITE 30
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-2053
Mailing Address - Country:US
Mailing Address - Phone:631-473-4284
Mailing Address - Fax:
Practice Address - Street 1:5225 NESCONSET HWY
Practice Address - Street 2:SUITE 30
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-2053
Practice Address - Country:US
Practice Address - Phone:631-473-4284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-01
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019994-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist