Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 194816 | NY |
NPI | 1154390383 |
---|---|
Provider Name | Deanna Lyons |
First Address | Dansville, NY 14437-0400 |
Second Address | Dansville, NY 14437-9502 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01657198 | (05) | NY |
G33154 | (02) | NY |