Provider Demographics
NPI:1326203654
Name:SIVA, SUE A (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SUE
Middle Name:A
Last Name:SIVA
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 SANTA CLARA CT
Mailing Address - Street 2:
Mailing Address - City:EAST AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14051-1482
Mailing Address - Country:US
Mailing Address - Phone:716-639-7827
Mailing Address - Fax:
Practice Address - Street 1:18 SANTA CLARA CT
Practice Address - Street 2:
Practice Address - City:EAST AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14051-1482
Practice Address - Country:US
Practice Address - Phone:716-639-7827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-25
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003700-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist