Healthcare Provider Details

I. General information

NPI: 1215104153
Provider Name (Legal Business Name): CHAMPLAIN VALLEY AUDIOLOGY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2008
Last Update Date: 03/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 US OVAL SUITE 3
PLATTSBURGH NY
12903-3900
US

IV. Provider business mailing address

176 US OVAL SUITE 3
PLATTSBURGH NY
12903-3900
US

V. Phone/Fax

Practice location:
  • Phone: 518-324-5707
  • Fax: 518-324-5726
Mailing address:
  • Phone: 518-324-5707
  • Fax: 518-324-5726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number1424
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number14000001179
License Number StateNY

VIII. Authorized Official

Name: DR. SHARON JOY MACNER
Title or Position: OWNER
Credential: AU.D.
Phone: 518-324-5707