Provider Demographics
NPI:1952599060
Name:D'EGIDIO, AMELYN (CERT MLD THERAPIST)
Entity type:Individual
Prefix:MRS
First Name:AMELYN
Middle Name:
Last Name:D'EGIDIO
Suffix:
Gender:F
Credentials:CERT MLD THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 CENTRAL AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LOS ALAMOS
Mailing Address - State:NM
Mailing Address - Zip Code:87544-3244
Mailing Address - Country:US
Mailing Address - Phone:505-662-3384
Mailing Address - Fax:
Practice Address - Street 1:1350 CENTRAL AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:LOS ALAMOS
Practice Address - State:NM
Practice Address - Zip Code:87544-3244
Practice Address - Country:US
Practice Address - Phone:505-662-3384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-15
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NP02813400164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse