Provider Demographics
NPI:1366741571
Name:MERRITT, MARYALYCE
Entity type:Individual
Prefix:MRS
First Name:MARYALYCE
Middle Name:
Last Name:MERRITT
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 1:191 POPLAR HILL RD
Mailing Address - Street 2:
Mailing Address - City:WASSAIC
Mailing Address - State:NY
Mailing Address - Zip Code:12592-2428
Mailing Address - Country:US
Mailing Address - Phone:845-729-8999
Mailing Address - Fax:
Practice Address - Street 1:8 OLD NORTH RD STE 2
Practice Address - Street 2:
Practice Address - City:AMENIA
Practice Address - State:NY
Practice Address - Zip Code:12501-5340
Practice Address - Country:US
Practice Address - Phone:845-244-0844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-28
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374K00000XNursing Service Related ProvidersReligious Nonmedical PractitionerGroup - Single Specialty
No175L00000XOther Service ProvidersHomeopathGroup - Single Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Single Specialty