Provider Demographics
NPI:1851649735
Name:DEMERCURIO, MALINDA (LAC)
Entity Type:Individual
Prefix:
First Name:MALINDA
Middle Name:
Last Name:DEMERCURIO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:MALINDA
Other - Middle Name:
Other - Last Name:SANDUCCI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:222 ROUTE 299 STE 12
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:NY
Mailing Address - Zip Code:12528-2524
Mailing Address - Country:US
Mailing Address - Phone:845-532-6723
Mailing Address - Fax:
Practice Address - Street 1:222 ROUTE 299 STE 12
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:NY
Practice Address - Zip Code:12528-2524
Practice Address - Country:US
Practice Address - Phone:845-532-6723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-26
Last Update Date:2020-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004427171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist