Provider Demographics
NPI:1902257330
Name:DEBLASIO, AMANDA
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:DEBLASIO
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 1:40 SUNSHINE COTTAGE RD
Mailing Address - Street 2:SKYLINE SUITE 1N-C08
Mailing Address - City:VALHALLA
Mailing Address - State:NY
Mailing Address - Zip Code:10595-1524
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:40 SUNSHINE COTTAGE RD
Practice Address - Street 2:SCHOOL OF HEALTH SCIENCES AND PRACTICE
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595-1524
Practice Address - Country:US
Practice Address - Phone:914-594-4239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-27
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024631235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist