Provider Demographics
NPI:1043455033
Name:MCDEVITT, LISA MARIE (AUD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:MARIE
Last Name:MCDEVITT
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 SOUTHERN BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:NESCONSET
Mailing Address - State:NY
Mailing Address - Zip Code:11767-1091
Mailing Address - Country:US
Mailing Address - Phone:631-238-5785
Mailing Address - Fax:631-238-5786
Practice Address - Street 1:57 SOUTHERN BLVD STE 4
Practice Address - Street 2:
Practice Address - City:NESCONSET
Practice Address - State:NY
Practice Address - Zip Code:11767-1091
Practice Address - Country:US
Practice Address - Phone:631-238-5785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-05
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002220-1231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist