Provider Demographics
NPI:1215288931
Name:MCCANN, DEANNA (LAC)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:
Last Name:MCCANN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:ENDICOTT
Mailing Address - State:NY
Mailing Address - Zip Code:13760-5468
Mailing Address - Country:US
Mailing Address - Phone:607-972-6220
Mailing Address - Fax:
Practice Address - Street 1:309 GRANT AVE
Practice Address - Street 2:
Practice Address - City:ENDICOTT
Practice Address - State:NY
Practice Address - Zip Code:13760-5468
Practice Address - Country:US
Practice Address - Phone:607-972-6220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-20
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004816-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist