Healthcare Provider Details

I. General information

NPI: 1649798240
Provider Name (Legal Business Name): AUDREY DEMAS MS ED.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2017
Last Update Date: 09/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 EXECUTIVE DRIVE SUITE LL 105/108
PLAINVIEW NY
11803
US

IV. Provider business mailing address

801 N VILLAGE AVE
ROCKVILLE CENTRE NY
11570-1200
US

V. Phone/Fax

Practice location:
  • Phone: 516-576-2040
  • Fax:
Mailing address:
  • Phone: 516-424-2683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: