Provider Demographics
NPI:1295177046
Name:WOOD, TAMMY LAURA
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:LAURA
Last Name:WOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:LAURA
Other - Last Name:LANGDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BC-HIS
Mailing Address - Street 1:1900 W GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13204-1814
Mailing Address - Country:US
Mailing Address - Phone:315-468-1926
Mailing Address - Fax:315-468-2169
Practice Address - Street 1:1900 W GENESEE ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13204-1814
Practice Address - Country:US
Practice Address - Phone:315-468-1926
Practice Address - Fax:315-468-2169
Is Sole Proprietor?:No
Enumeration Date:2013-07-22
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY14000016596237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY14000016596OtherNEW YORK STATE LICENSE NUMBER