Provider Demographics
NPI:1487922597
Name:AMELL, SUE A (LMT)
Entity type:Individual
Prefix:
First Name:SUE
Middle Name:A
Last Name:AMELL
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 1:75 LAKEVIEW TER
Mailing Address - Street 2:
Mailing Address - City:SARANAC LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12983-2419
Mailing Address - Country:US
Mailing Address - Phone:518-524-8787
Mailing Address - Fax:518-354-8047
Practice Address - Street 1:75 LAKEVIEW TER
Practice Address - Street 2:
Practice Address - City:SARANAC LAKE
Practice Address - State:NY
Practice Address - Zip Code:12983-2419
Practice Address - Country:US
Practice Address - Phone:518-524-8787
Practice Address - Fax:518-354-8047
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-02
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014155-1171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor