Provider Demographics
NPI:1417933532
Name:ROBERTS, SUSAN ANN TERRANOVA (AUD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:ANN TERRANOVA
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:ANN
Other - Last Name:TERRANOVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:52 BIOMEDICAL EDUCATION BUILDING
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-8016
Mailing Address - Country:US
Mailing Address - Phone:716-829-3980
Mailing Address - Fax:716-829-3974
Practice Address - Street 1:52 BIOMEDICAL EDUCATION BUILDING
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-8016
Practice Address - Country:US
Practice Address - Phone:716-829-3980
Practice Address - Fax:716-829-3974
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0009191231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000576077003OtherBC CB ADV SB
9210117OtherINDEPENDENT HEALTH
00011240404OtherUNIVERA GROUP
AA1308OtherGROUP
AA1308OtherGROUP