Provider Demographics
NPI:1477676302
Name:BUZARD, SHERRY MAUREEN (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:MAUREEN
Last Name:BUZARD
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14911 ROUTE 28 APT A
Mailing Address - Street 2:
Mailing Address - City:CORSICA
Mailing Address - State:PA
Mailing Address - Zip Code:15829-2435
Mailing Address - Country:US
Mailing Address - Phone:814-856-2552
Mailing Address - Fax:815-856-2552
Practice Address - Street 1:14911 ROUTE 28 APT A
Practice Address - Street 2:
Practice Address - City:CORSICA
Practice Address - State:PA
Practice Address - Zip Code:15829-2435
Practice Address - Country:US
Practice Address - Phone:814-856-2552
Practice Address - Fax:815-856-2552
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-07
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202006119235Z00000X
NC12912235Z00000X
NY028253235Z00000X
FLSA16221235Z00000X
PASL007133235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1008635440001Medicaid