Provider Demographics
NPI:1518954304
Name:WATERS, HELEN M (AUD CCCA MS BS)
Entity Type:Individual
Prefix:MRS
First Name:HELEN
Middle Name:M
Last Name:WATERS
Suffix:
Gender:F
Credentials:AUD CCCA MS BS
Other - Prefix:MISS
Other - First Name:HELEN
Other - Middle Name:V
Other - Last Name:MICHALIK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:721 E GENESEE ST
Mailing Address - Street 2:FL 2
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1505
Mailing Address - Country:US
Mailing Address - Phone:315-476-3127
Mailing Address - Fax:315-476-3136
Practice Address - Street 1:721 E GENESEE ST
Practice Address - Street 2:FL 2
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1505
Practice Address - Country:US
Practice Address - Phone:315-476-3127
Practice Address - Fax:315-476-3136
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000351207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00561353Medicaid
NY00561353Medicaid
J51672Medicare UPIN