Healthcare Provider Details

I. General information

NPI: 1063346013
Provider Name (Legal Business Name): MRS. AMANDA DEMOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2469 COUNTY ROUTE 45
FULTON NY
13069-3670
US

IV. Provider business mailing address

2469 COUNTY ROUTE 45
FULTON NY
13069-3670
US

V. Phone/Fax

Practice location:
  • Phone: 315-474-5506
  • Fax: 315-474-1554
Mailing address:
  • Phone: 315-474-5506
  • Fax: 315-474-1554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: