Provider Demographics
NPI:1992804710
Name:TERRY, WAYNE (MA,FAAA)
Entity type:Individual
Prefix:
First Name:WAYNE
Middle Name:
Last Name:TERRY
Suffix:
Gender:M
Credentials:MA,FAAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX C
Mailing Address - Street 2:194 MAIN ST.
Mailing Address - City:UNADILLA
Mailing Address - State:NY
Mailing Address - Zip Code:13849-0703
Mailing Address - Country:US
Mailing Address - Phone:607-369-3802
Mailing Address - Fax:607-369-5802
Practice Address - Street 1:194 MAIN STREET
Practice Address - Street 2:
Practice Address - City:UNADILLA
Practice Address - State:NY
Practice Address - Zip Code:13849-0703
Practice Address - Country:US
Practice Address - Phone:607-369-3802
Practice Address - Fax:607-369-5802
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001276-1231H00000X
NY14000001180237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY56617BMedicare PIN