MEDICARE: SUZANNE GUNDERSON CRISAFULLI M.A.

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	237600000X	Audiologist-Hearing Aid Fitter	51533	TX

General Provider Information

NPI Number	:	1477742054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUZANNE GUNDERSON CRISAFULLI M.A.

Provider Business Mailing Address
First Line	:	2908 SAINT VINCENT DR
Second Line	:
City	:	MANSFIELD
State	:	TX
Zip	:	76063-7654
Country	:	US
Telephone Number	:	682-518-0021
Fax Number	:

Provider Business Practice Location Address
First Line	:	1521 N COOPER ST STE 210
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76011-5522
Country	:	US
Telephone Number	:	817-983-2550
Fax Number	:	817-983-2551

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

Provider Enumeration Date	:	10/18/2007
Last Update Date	:	10/18/2007

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