MEDICARE: SARAH BUNYE GRIESEDIECK

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	235Z00000X	Speech-Language Pathologist	14275	NC

General Provider Information

NPI Number	:	1184235665
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH BUNYE GRIESEDIECK

Provider Business Mailing Address
First Line	:	14 FOX CHASE LN
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27713-9458
Country	:	US
Telephone Number	:	919-603-4681
Fax Number	:

Provider Business Practice Location Address
First Line	:	2301 ERWIN ROAD
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27710-6503
Country	:	US
Telephone Number	:	919-603-4681
Fax Number	:

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

Provider Enumeration Date	:	08/10/2020
Last Update Date	:	07/22/2021

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Directions to “ SARAH BUNYE GRIESEDIECK ” Practice Location

Language	Start Address	Practice Location

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