Provider Demographics
NPI:1124451273
Name:DEMONTE, KELLIE (MS SPED)
Entity type:Individual
Prefix:
First Name:KELLIE
Middle Name:
Last Name:DEMONTE
Suffix:
Gender:F
Credentials:MS SPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 DAVID ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10308-3120
Mailing Address - Country:US
Mailing Address - Phone:718-227-7317
Mailing Address - Fax:
Practice Address - Street 1:80 WOODROW RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-1313
Practice Address - Country:US
Practice Address - Phone:718-356-0008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-13
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY362234031174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist