Provider Demographics
NPI:1821546474
Name:DIMMICK, ASHLEY NOEL (MSED)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:NOEL
Last Name:DIMMICK
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3225 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:ENDICOTT
Mailing Address - State:NY
Mailing Address - Zip Code:13760-5757
Mailing Address - Country:US
Mailing Address - Phone:607-206-5539
Mailing Address - Fax:
Practice Address - Street 1:236 BURTS RD
Practice Address - Street 2:
Practice Address - City:KIRKWOOD
Practice Address - State:NY
Practice Address - Zip Code:13795-1731
Practice Address - Country:US
Practice Address - Phone:877-426-3307
Practice Address - Fax:877-426-3307
Is Sole Proprietor?:No
Enumeration Date:2016-09-12
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY981281151174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist