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General NPI Number Information
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NPI Number | 1972998185
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Entity Type | Individual
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Provider Name | LORI EVELYN DEMAYO FNP
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Gender | Female
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Dates
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Enumeration Date | 04/03/2015
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Last Update Date | 01/15/2026
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Provider Practice Location Address
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Address Line | 114 E MAIN ST
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City | CLINTON
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State | CT
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Zip | 06413-2131
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Country | US
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Telephone | 860-664-0787
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Fax | 860-664-1982
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Provider Business Mailing Address
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Address Line | 19 GRAND ST
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City | MIDDLETOWN
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State | CT
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Zip | 06457-2705
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Country | US
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Telephone | 860-347-6971
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Fax | 860-343-7371
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APN.0991458-NP
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | E56954
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 14537
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License Number State | CT
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Taxonomy #4
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN.0160910
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License Number State | CO
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