Healthcare Provider Details

I. General information

NPI: 1639340490
Provider Name (Legal Business Name): SUZANNE WILLIAMS AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUZANNE MEMMELAAR AU.D.

II. Dates (important events)

Enumeration Date: 03/19/2008
Last Update Date: 05/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 OLD ROUTE 17
MONTICELLO NY
12701-7013
US

IV. Provider business mailing address

PO BOX 840
HARRIS NY
12742-0840
US

V. Phone/Fax

Practice location:
  • Phone: 845-707-8400
  • Fax:
Mailing address:
  • Phone: 845-794-1400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number001915-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number14000017084
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: