Healthcare Provider Details

I. General information

NPI: 1538473822
Provider Name (Legal Business Name): ANGELA JEANNE PUSZTAY M.A. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2010
Last Update Date: 07/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 DAVIS RD
WEST FALLS NY
14170-9701
US

IV. Provider business mailing address

1850 DAVIS RD
WEST FALLS NY
14170-9701
US

V. Phone/Fax

Practice location:
  • Phone: 716-655-8826
  • Fax:
Mailing address:
  • Phone: 716-655-8826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number019477
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: