Provider Demographics
NPI:1023010550
Name:DEBRUYNE, SUSAN S (AUD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:S
Last Name:DEBRUYNE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 E SOUTH ST
Mailing Address - Street 2:SUITE 400A
Mailing Address - City:GENESEO
Mailing Address - State:NY
Mailing Address - Zip Code:14454-1300
Mailing Address - Country:US
Mailing Address - Phone:585-243-7690
Mailing Address - Fax:585-243-9208
Practice Address - Street 1:50 E SOUTH ST
Practice Address - Street 2:SUITE 400A
Practice Address - City:GENESEO
Practice Address - State:NY
Practice Address - Zip Code:14454-1300
Practice Address - Country:US
Practice Address - Phone:585-243-7690
Practice Address - Fax:585-243-9208
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1451231H00000X, 332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
103459AIOtherPREFERRED CARE
80121005800921OtherBC/BS OF WESTERN NY
80121009160363OtherBC/BS OF WESTERN NY
7700242OtherMVP HEALTHCARE
7882382OtherAETNA
00580092001OtherBC/BS OF WESTERN NY
80121009160363OtherBC/BS OF WESTERN NY
CC4392Medicare ID - Type Unspecified