Provider Demographics
NPI:1750527164
Name:BRADBURY, AMY MARIE (AUD CCC-A)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:MARIE
Last Name:BRADBURY
Suffix:
Gender:F
Credentials:AUD CCC-A
Other - Prefix:MS
Other - First Name:AMY
Other - Middle Name:MARIE
Other - Last Name:GLESSING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-A
Mailing Address - Street 1:6296 FLY RD
Mailing Address - Street 2:
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-9333
Mailing Address - Country:US
Mailing Address - Phone:315-701-5710
Mailing Address - Fax:315-701-5711
Practice Address - Street 1:6296 FLY RD
Practice Address - Street 2:
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-9333
Practice Address - Country:US
Practice Address - Phone:315-701-5710
Practice Address - Fax:315-701-5711
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-07
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001847-1231H00000X
NY14000014540237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist