MEDICARE: WAYNE TERRY M.A.,F.A.A.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	001276-1	NY
2	237600000X	Audiologist-Hearing Aid Fitter	14000001180	NY

General Provider Information

NPI Number	:	1992804710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WAYNE TERRY M.A.,F.A.A.A.

Provider Business Mailing Address
First Line	:	PO BOX C
Second Line	:	194 MAIN ST.
City	:	UNADILLA
State	:	NY
Zip	:	13849-0703
Country	:	US
Telephone Number	:	607-369-3802
Fax Number	:	607-369-5802

Provider Business Practice Location Address
First Line	:	194 MAIN STREET
Second Line	:
City	:	UNADILLA
State	:	NY
Zip	:	13849-0703
Country	:	US
Telephone Number	:	607-369-3802
Fax Number	:	607-369-5802

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

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	09/01/2015

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