Healthcare Provider Details

I. General information

NPI: 1508439324
Provider Name (Legal Business Name): MARYANN BROCK AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2021
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3980 SHERIDAN DR
AMHERST NY
14226-1727
US

IV. Provider business mailing address

24 HEATHWOOD RD
WILLIAMSVILLE NY
14221-4616
US

V. Phone/Fax

Practice location:
  • Phone: 716-250-2000
  • Fax:
Mailing address:
  • Phone: 716-250-3083
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number3023
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: