Healthcare Provider Details

I. General information

NPI: 1376565697
Provider Name (Legal Business Name): JUDY J. SCHAEFFLER M.S. AUDIOLOGY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 03/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1554 MOUNT ZOAR RD
PINE CITY NY
14871-9545
US

IV. Provider business mailing address

1554 MOUNT ZOAR RD
PINE CITY NY
14871-9545
US

V. Phone/Fax

Practice location:
  • Phone: 607-734-2104
  • Fax: 607-733-9558
Mailing address:
  • Phone: 607-734-2104
  • Fax: 607-733-9558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number000208-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: