MEDICARE: MS. KRISTIN STACEY BRUNO MS

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	010403-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	09129636	OTHER	NY	ASHA

General Provider Information

NPI Number	:	1356570196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KRISTIN STACEY BRUNO MS

Provider Business Mailing Address
First Line	:	8 DUNES LN
Second Line	:
City	:	PORT WASHINGTON
State	:	NY
Zip	:	11050-1408
Country	:	US
Telephone Number	:	516-857-4525
Fax Number	:

Provider Business Practice Location Address
First Line	:	8 DUNES LN
Second Line	:
City	:	PORT WASHINGTON
State	:	NY
Zip	:	11050-1408
Country	:	US
Telephone Number	:	516-857-4525
Fax Number	:

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

Provider Enumeration Date	:	07/14/2009
Last Update Date	:	07/14/2009

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