Provider Demographics
NPI:1972520989
Name:SUN, STEPHANY LEE (MS, CCC-A)
Entity Type:Individual
Prefix:
First Name:STEPHANY
Middle Name:LEE
Last Name:SUN
Suffix:
Gender:F
Credentials:MS, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1265 HIGHWAY 54 W
Mailing Address - Street 2:SUITE 304
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-4548
Mailing Address - Country:US
Mailing Address - Phone:678-817-4390
Mailing Address - Fax:678-817-4394
Practice Address - Street 1:1265 HIGHWAY 54 W
Practice Address - Street 2:SUITE 304
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-4548
Practice Address - Country:US
Practice Address - Phone:678-817-4390
Practice Address - Fax:678-817-4394
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAUD003651231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist