Provider Demographics
NPI:1033580774
Name:DEMAR, AMY S
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:S
Last Name:DEMAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:242 FLOWER AVE W
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-3937
Mailing Address - Country:US
Mailing Address - Phone:315-408-2609
Mailing Address - Fax:
Practice Address - Street 1:727 WASHINGTON ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-6737
Practice Address - Country:US
Practice Address - Phone:315-755-1951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-07
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY14000040513237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist