Provider Demographics
NPI:1316039944
Name:SUMBRUM, AMY (SLP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:SUMBRUM
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 1:6590 E QUAKER RD
Mailing Address - Street 2:BUILDING 1, LOWER
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-1236
Mailing Address - Country:US
Mailing Address - Phone:716-608-3366
Mailing Address - Fax:716-322-2566
Practice Address - Street 1:6590 E QUAKER RD
Practice Address - Street 2:BUILDING 1, LOWER
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1236
Practice Address - Country:US
Practice Address - Phone:716-608-3366
Practice Address - Fax:716-322-2566
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013794235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02792152Medicaid
NYJ400004055Medicare PIN