MEDICARE: DR. SUSAN S. DEBRUYNE AU.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332S00000X	Hearing Aid Equipment	14000010429	NY
2	231H00000X	Audiologist	1451	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	640004655	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	7700242	OTHER	MVP HEALTHCARE
2	82564	OTHER	EXCELLUS BCBS
3	7882382	OTHER	AETNA

General Provider Information

NPI Number	:	1023010550
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN S. DEBRUYNE AU.D

Provider Business Mailing Address
First Line	:	3513 THOMAS DR STE 2
Second Line	:
City	:	LAKEVILLE
State	:	NY
Zip	:	14480-9759
Country	:	US
Telephone Number	:	585-243-7690
Fax Number	:	585-346-7582

Provider Business Practice Location Address
First Line	:	3513 THOMAS DR STE 2
Second Line	:
City	:	LAKEVILLE
State	:	NY
Zip	:	14480-9759
Country	:	US
Telephone Number	:	585-243-7690
Fax Number	:	585-346-7582

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	05/31/2024

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