Provider Demographics
NPI:1700140571
Name:FUSSA, MARYBETH LYNN (MSED)
Entity Type:Individual
Prefix:MS
First Name:MARYBETH
Middle Name:LYNN
Last Name:FUSSA
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 COUNTRY DOWNS CIR
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-8808
Mailing Address - Country:US
Mailing Address - Phone:585-766-1451
Mailing Address - Fax:
Practice Address - Street 1:97 COUNTRY DOWNS CIR
Practice Address - Street 2:
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-8808
Practice Address - Country:US
Practice Address - Phone:585-766-1451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-26
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist