Provider Demographics
NPI:1356733232
Name:DEMASELLIS, GUY (AGNP-C)
Entity type:Individual
Prefix:
First Name:GUY
Middle Name:
Last Name:DEMASELLIS
Suffix:
Gender:M
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1614 BIRNEY ST
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-2824
Mailing Address - Country:US
Mailing Address - Phone:989-233-1634
Mailing Address - Fax:
Practice Address - Street 1:1614 BIRNEY ST
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-2824
Practice Address - Country:US
Practice Address - Phone:989-233-1634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-02
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704231409363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner