Provider Demographics
NPI:1497120711
Name:AMIDON, SIANI YM (MS, CAS, NCSP)
Entity Type:Individual
Prefix:MRS
First Name:SIANI
Middle Name:YM
Last Name:AMIDON
Suffix:
Gender:F
Credentials:MS, CAS, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3353 PLEASANT VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13215-8673
Mailing Address - Country:US
Mailing Address - Phone:315-857-4916
Mailing Address - Fax:
Practice Address - Street 1:3353 PLEASANT VALLEY RD
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13215-8673
Practice Address - Country:US
Practice Address - Phone:315-857-4916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-11
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2385240174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist