Provider Demographics
NPI:1063079812
Name:SCALAMANDRE, ERICA D
Entity type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:D
Last Name:SCALAMANDRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 STAGE RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950-3512
Mailing Address - Country:US
Mailing Address - Phone:845-827-6227
Mailing Address - Fax:
Practice Address - Street 1:32 SHARON DR
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-3620
Practice Address - Country:US
Practice Address - Phone:845-406-3935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-28
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator