Provider Demographics
NPI:1376040147
Name:DICK, AMELIA JOYCE
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:JOYCE
Last Name:DICK
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 1:1002 STRAWBERRY LN
Mailing Address - Street 2:
Mailing Address - City:BIG FLATS
Mailing Address - State:NY
Mailing Address - Zip Code:14814-8952
Mailing Address - Country:US
Mailing Address - Phone:607-377-6344
Mailing Address - Fax:
Practice Address - Street 1:1002 STRAWBERRY LN
Practice Address - Street 2:
Practice Address - City:BIG FLATS
Practice Address - State:NY
Practice Address - Zip Code:14814-8952
Practice Address - Country:US
Practice Address - Phone:607-377-6344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-09
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist