Provider Demographics
NPI:1427566843
Name:LEMONDA, ELYSE BETH
Entity Type:Individual
Prefix:MRS
First Name:ELYSE
Middle Name:BETH
Last Name:LEMONDA
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 1:53 SANDY HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-2530
Mailing Address - Country:US
Mailing Address - Phone:516-883-0270
Mailing Address - Fax:
Practice Address - Street 1:53 SANDY HOLLOW RD
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-2530
Practice Address - Country:US
Practice Address - Phone:516-883-0270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-19
Last Update Date:2018-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty