Provider Demographics
NPI:1790015352
Name:FUNDALINSKI, SUZANNE (LMT)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:
Last Name:FUNDALINSKI
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:757 PARKSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14216-2437
Mailing Address - Country:US
Mailing Address - Phone:716-598-2607
Mailing Address - Fax:
Practice Address - Street 1:4511 MAIN ST
Practice Address - Street 2:
Practice Address - City:SNYDER
Practice Address - State:NY
Practice Address - Zip Code:14226-3809
Practice Address - Country:US
Practice Address - Phone:716-839-6585
Practice Address - Fax:716-839-6585
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-05
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019727-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist