Provider Demographics
NPI:1689076531
Name:DEMAYO, TIFFANY ANN
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:ANN
Last Name:DEMAYO
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 1:137 DUG RD
Mailing Address - Street 2:
Mailing Address - City:ACCORD
Mailing Address - State:NY
Mailing Address - Zip Code:12404-5917
Mailing Address - Country:US
Mailing Address - Phone:845-853-2989
Mailing Address - Fax:
Practice Address - Street 1:137 DUG RD
Practice Address - Street 2:
Practice Address - City:ACCORD
Practice Address - State:NY
Practice Address - Zip Code:12404-5917
Practice Address - Country:US
Practice Address - Phone:845-853-2989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-23
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY319871-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse