Provider Demographics
NPI:1639340490
Name:WILLIAMS, SUZANNE (AUD)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:
Other - Last Name:MEMMELAAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:PO BOX 840
Mailing Address - Street 2:
Mailing Address - City:HARRIS
Mailing Address - State:NY
Mailing Address - Zip Code:12742-0840
Mailing Address - Country:US
Mailing Address - Phone:845-794-1400
Mailing Address - Fax:
Practice Address - Street 1:606 OLD ROUTE 17
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:NY
Practice Address - Zip Code:12701-7013
Practice Address - Country:US
Practice Address - Phone:845-707-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-19
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001915-1231H00000X
NY14000017084237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400003130Medicare PIN