Provider Demographics
NPI:1740722297
Name:HAMM, LYNEE (LMT)
Entity type:Individual
Prefix:
First Name:LYNEE
Middle Name:
Last Name:HAMM
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6607 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:JORDAN
Mailing Address - State:NY
Mailing Address - Zip Code:13080-9706
Mailing Address - Country:US
Mailing Address - Phone:315-391-6263
Mailing Address - Fax:
Practice Address - Street 1:109 PINE ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1149
Practice Address - Country:US
Practice Address - Phone:315-391-6263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-15
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024146174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist