Provider Demographics
NPI:1508469701
Name:MUSHTARE, ERIN
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:MUSHTARE
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 1:469 W DELAVAN AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14213-1414
Mailing Address - Country:US
Mailing Address - Phone:607-353-9978
Mailing Address - Fax:
Practice Address - Street 1:30 HAZELWOOD DR
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14228-2234
Practice Address - Country:US
Practice Address - Phone:716-631-5777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030314235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist