Healthcare Provider Details

I. General information

NPI: 1245193879
Provider Name (Legal Business Name): DEMI REECE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 LATIMER HILL RD
CANAJOHARIE NY
13317-3744
US

IV. Provider business mailing address

1700 LATIMER HILL RD
CANAJOHARIE NY
13317-3744
US

V. Phone/Fax

Practice location:
  • Phone: 347-322-1792
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number357059
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: