Provider Demographics
NPI:1679814313
Name:DEMEESTER, MCKAY NEWTON (HIS)
Entity type:Individual
Prefix:
First Name:MCKAY
Middle Name:NEWTON
Last Name:DEMEESTER
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 COMMONWEALTH RD
Mailing Address - Street 2:2D
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-1526
Mailing Address - Country:US
Mailing Address - Phone:508-545-2155
Mailing Address - Fax:508-545-2441
Practice Address - Street 1:5 COMMONWEALTH RD
Practice Address - Street 2:2D
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-1526
Practice Address - Country:US
Practice Address - Phone:508-545-2155
Practice Address - Fax:508-545-2441
Is Sole Proprietor?:No
Enumeration Date:2013-03-05
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QH0700X237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist