Provider Demographics
NPI:1962888487
Name:SMYCZYNSKI, ALYSSA D (AUD)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:D
Last Name:SMYCZYNSKI
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:D
Other - Last Name:BEATON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4600 MAIN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-4500
Mailing Address - Country:US
Mailing Address - Phone:716-833-4488
Mailing Address - Fax:716-839-1218
Practice Address - Street 1:4600 MAIN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-4500
Practice Address - Country:US
Practice Address - Phone:716-833-4488
Practice Address - Fax:716-839-1218
Is Sole Proprietor?:No
Enumeration Date:2015-08-06
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002616231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist