Provider Demographics
NPI:1184288565
Name:MONTLEON, AMELIA MARIE (BA)
Entity type:Individual
Prefix:
First Name:AMELIA
Middle Name:MARIE
Last Name:MONTLEON
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3039 N OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11738-2913
Mailing Address - Country:US
Mailing Address - Phone:631-375-5102
Mailing Address - Fax:
Practice Address - Street 1:3039 N OCEAN AVE
Practice Address - Street 2:
Practice Address - City:FARMINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:11738-2913
Practice Address - Country:US
Practice Address - Phone:631-375-5102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-01
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3796501174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist