Basic Information
| Provider Information | |||||||||
| NPI: | 1124451273 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DEMONTE | ||||||||
| FirstName: | KELLIE | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.S. SP.ED. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 149 DAVID ST | ||||||||
| Address2: | |||||||||
| City: | STATEN ISLAND | ||||||||
| State: | NY | ||||||||
| PostalCode: | 103083120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182277317 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 80 WOODROW RD | ||||||||
| Address2: | |||||||||
| City: | STATEN ISLAND | ||||||||
| State: | NY | ||||||||
| PostalCode: | 103121313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7183560008 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2013 | ||||||||
| LastUpdateDate: | 08/13/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 362234031 | NY | Y | Other Service Providers | Specialist |
No ID Information.