Provider Demographics
NPI:1962406678
Name:CHUNYK, SUSAN BANKOSKI (AUD, CCC-A)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:BANKOSKI
Last Name:CHUNYK
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EAST LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01028-2392
Mailing Address - Country:US
Mailing Address - Phone:413-525-7979
Mailing Address - Fax:413-525-8303
Practice Address - Street 1:200 N MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01028-2392
Practice Address - Country:US
Practice Address - Phone:413-525-7979
Practice Address - Fax:413-525-8303
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA265231H00000X
CT000166231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAG0006OtherBCBS GROUP NUMBER
MA9712950Medicaid
MA5102448Medicaid
MAAD0023OtherBC/BS INDIVIDUAL NUMBER
MA000000020602OtherBMC HEALTHNET INDIVIDUAL
MAHA022964Medicare ID - Type UnspecifiedGROUP NUMBER
MA9712950Medicaid