MEDICARE: DR. SUSAN BANKOSKI CHUNYK AU.D., CCC-A

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	231H00000X	Audiologist	265	MA
2	231H00000X	Audiologist	000166	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AG0006	OTHER	MA	BCBS GROUP NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	AD0023	OTHER	MA	BC/BS INDIVIDUAL NUMBER
5	000000020602	OTHER	MA	BMC HEALTHNET INDIVIDUAL

General Provider Information

NPI Number	:	1962406678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN BANKOSKI CHUNYK AU.D., CCC-A

Provider Business Mailing Address
First Line	:	200 N MAIN ST
Second Line	:
City	:	EAST LONGMEADOW
State	:	MA
Zip	:	01028-2392
Country	:	US
Telephone Number	:	413-525-7979
Fax Number	:	413-525-8303

Provider Business Practice Location Address
First Line	:	200 N MAIN ST
Second Line	:
City	:	EAST LONGMEADOW
State	:	MA
Zip	:	01028-2392
Country	:	US
Telephone Number	:	413-525-7979
Fax Number	:	413-525-8303

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

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	07/09/2007

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Directions to “ DR. SUSAN BANKOSKI CHUNYK AU.D., CCC-A” Practice Location

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