Individual provider Active NPI

Amy Edwards Wenner, CCC-A

  • Audiologist
  • Syracuse, NY
National Provider Identifier
1306093141
Registry record updated Aug 27, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
License
57001735 Issued in NY
Practice address
4424 Dolomite Drive
Syracuse, NY 13215
Phone
(315) 487-0325
NPI assigned
Aug 23, 2008
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 27, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist 231H00000X 57001735 NY Primary

Addresses

Primary practice location

4424 Dolomite Drive
Syracuse, NY 13215

Mailing address

4424 Dolomite Dr
Syracuse, NY 13215-1582
Phone (315) 487-0325

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
57001735NYMDAudiologist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1219449600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1377561600000",
    "number": "1306093141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4424 DOLOMITE DR",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132151582",
            "telephone_number": "315-487-0325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4424 DOLOMITE DRIVE",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "13215",
            "telephone_number": "315-487-0325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WENNER",
        "first_name": "AMY",
        "middle_name": "EDWARDS",
        "name_prefix": "Mrs.",
        "credential": "CCC-A",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-08-23",
        "last_updated": "2013-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "NY",
            "license": "57001735",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Syracuse, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.