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NPI Code Detail

MEDICARE: MS. SALLY ANN BACON AUD

MEDICARE: MS. SALLY ANN BACON AUD
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
1231H00000XAudiologist

General Provider Information

NPI Number : 1962478156
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SALLY ANN BACON AUD
Provider Business Mailing Address
First Line : 3599 BIG RIDGE RD.
Second Line :
City : SPENCERPORT
State : NY
Zip : 14559
Country : US
Telephone Number : 585-352-2440
Fax Number :
Provider Business Practice Location Address
First Line : 3599 BIG RIDGE RD
Second Line :
City : SPENCERPORT
State : NY
Zip : 14559-1709
Country : US
Telephone Number : 585-352-2440
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/27/2006
Last Update Date : 10/15/2011

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