MEDICARE: SUZANNE MARIE RIZZO MA, CCC, SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	007782-1	NY

General Provider Information

NPI Number	:	1235284522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUZANNE MARIE RIZZO MA, CCC, SLP

Provider Business Mailing Address
First Line	:	124 BARRAUD DR
Second Line	:
City	:	PORT JEFFERSON STATION
State	:	NY
Zip	:	11776-8011
Country	:	US
Telephone Number	:	631-476-4513
Fax Number	:

Provider Business Practice Location Address
First Line	:	2171 JERICHO TPKE
Second Line	:	SUITE 340
City	:	COMMACK
State	:	NY
Zip	:	11725-2937
Country	:	US
Telephone Number	:	631-499-5595
Fax Number	:	631-499-3060

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	07/08/2007

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