MEDICARE: DEMEETRIO BUTLER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376K00000X	Nurse's Aide	NYAZ0500098R	NY

General Provider Information

NPI Number	:	1235074980
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEMEETRIO BUTLER

Provider Business Mailing Address
First Line	:	1 FREEMAN CT
Second Line	:
City	:	COMMACK
State	:	NY
Zip	:	11725-3911
Country	:	US
Telephone Number	:	347-909-6036
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 FREEMAN CT
Second Line	:
City	:	COMMACK
State	:	NY
Zip	:	11725-3911
Country	:	US
Telephone Number	:	347-909-6036
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2026
Last Update Date	:	04/20/2026

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Directions to “ DEMEETRIO BUTLER ” Practice Location

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