Provider Demographics
NPI:1952630030
Name:DAMON, AMY AGATHA (LPN)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:AGATHA
Last Name:DAMON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120-38 231 STREET
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11411-2220
Mailing Address - Country:US
Mailing Address - Phone:718-723-7516
Mailing Address - Fax:718-723-7516
Practice Address - Street 1:115-23 224 STREET
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11411-2220
Practice Address - Country:US
Practice Address - Phone:718-723-7516
Practice Address - Fax:718-723-7516
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-18
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY296991-1251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care