Provider Demographics
NPI:1023010550
Name:DEBRUYNE, SUSAN S (AUD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:S
Last Name:DEBRUYNE
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 1:3513 THOMAS DR STE 2
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14480-9759
Mailing Address - Country:US
Mailing Address - Phone:585-243-7690
Mailing Address - Fax:585-346-7582
Practice Address - Street 1:3513 THOMAS DR STE 2
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:NY
Practice Address - Zip Code:14480-9759
Practice Address - Country:US
Practice Address - Phone:585-243-7690
Practice Address - Fax:585-346-7582
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY14000010429332S00000X
NY1451231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
7700242OtherMVP HEALTHCARE
82564OtherEXCELLUS BCBS
7882382OtherAETNA
640004655OtherRAILROAD MEDICARE
7882382OtherAETNA
00580092001OtherBC/BS OF WESTERN NY
80121009160363OtherBC/BS OF WESTERN NY
CC4392Medicare ID - Type Unspecified