Provider Demographics
NPI:1598822777
Name:PACE, SUZETTE ANNE (AUD)
Entity Type:Individual
Prefix:DR
First Name:SUZETTE
Middle Name:ANNE
Last Name:PACE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1033 STATE ROUTE 13
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13045
Mailing Address - Country:US
Mailing Address - Phone:607-756-1053
Mailing Address - Fax:607-299-4547
Practice Address - Street 1:1033 STATE ROUTE 13
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045
Practice Address - Country:US
Practice Address - Phone:607-756-1053
Practice Address - Fax:607-299-4547
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001689231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
J400054121Medicare PIN