Provider Demographics
NPI:1992976963
Name:FAUGHNAN, THERESA (MA)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:FAUGHNAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ELM ST
Mailing Address - Street 2:
Mailing Address - City:TUCKAHOE
Mailing Address - State:NY
Mailing Address - Zip Code:10707-3925
Mailing Address - Country:US
Mailing Address - Phone:914-961-2515
Mailing Address - Fax:914-961-2628
Practice Address - Street 1:1 ELM ST
Practice Address - Street 2:
Practice Address - City:TUCKAHOE
Practice Address - State:NY
Practice Address - Zip Code:10707-3925
Practice Address - Country:US
Practice Address - Phone:914-961-2515
Practice Address - Fax:914-961-2628
Is Sole Proprietor?:No
Enumeration Date:2008-03-18
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000842-1231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400000296Medicare PIN