Healthcare Provider Details

I. General information

NPI: 1306811302
Provider Name (Legal Business Name): SUSAN A MERENDA CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ESSEX CENTER DR 4TH FLOOR
PEABODY MA
01960-2901
US

IV. Provider business mailing address

51 SALISBURY ST
WINCHESTER MA
01890-2436
US

V. Phone/Fax

Practice location:
  • Phone: 978-538-3600
  • Fax: 978-538-3610
Mailing address:
  • Phone: 781-729-4259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number142
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: