Provider Demographics
NPI:1326369505
Name:SYRACUSE, DIANA JO
Entity Type:Individual
Prefix:MRS
First Name:DIANA JO
Middle Name:
Last Name:SYRACUSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 LANDINGS DR
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14228-3713
Mailing Address - Country:US
Mailing Address - Phone:716-691-5740
Mailing Address - Fax:
Practice Address - Street 1:345 OLYMPIC AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-2748
Practice Address - Country:US
Practice Address - Phone:716-816-3340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-22
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY470641Medicaid