Provider Demographics
NPI:1225213572
Name:DEFAZIO, MARCIA A (SLP)
Entity Type:Individual
Prefix:MS
First Name:MARCIA
Middle Name:A
Last Name:DEFAZIO
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 DELAWARE AVE
Mailing Address - Street 2:400
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14202-1212
Mailing Address - Country:US
Mailing Address - Phone:716-826-2010
Mailing Address - Fax:716-819-0279
Practice Address - Street 1:560 DELAWARE AVE
Practice Address - Street 2:400
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202-1212
Practice Address - Country:US
Practice Address - Phone:716-826-2010
Practice Address - Fax:716-819-0279
Is Sole Proprietor?:No
Enumeration Date:2008-01-07
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015404-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist