Healthcare Provider Details

I. General information

NPI: 1750252334
Provider Name (Legal Business Name): NATALIE ROSE WUNDER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2025
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 CONTINUUM DR STE A
LIVERPOOL NY
13088-4387
US

IV. Provider business mailing address

7540 BUCKLEY RD APT 106
NORTH SYRACUSE NY
13212-1056
US

V. Phone/Fax

Practice location:
  • Phone: 315-450-4898
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberP135519
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: