Provider Demographics
NPI:1891923488
Name:BRUNETTO, MIRIAH D (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MIRIAH
Middle Name:D
Last Name:BRUNETTO
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 INTERNATIONAL DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5781
Mailing Address - Country:US
Mailing Address - Phone:716-984-8522
Mailing Address - Fax:
Practice Address - Street 1:300 INTERNATIONAL DR STE 100
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5783
Practice Address - Country:US
Practice Address - Phone:716-984-8522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-23
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018920-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist