Mikelle Demmerley

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

311324 Issued in NY

Practice address

210 E Main St Ste 301
Springville, NY 14141-1453

Phone

(716) 592-2832

NPI assigned

Apr 7, 2018

Sex

Female

Sole proprietor

No

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Seneca Nation of Indians

  • Federally Qualified Health Center (FQHC)
  • Salamanca, NY
  • NPI 1023033511
  NPD (past)

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Apr 21, 2025.

{
    "created_epoch": "1523059200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745193600000",
    "number": "1437656345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 E MAIN ST STE 301",
            "city": "SPRINGVILLE",
            "state": "NY",
            "postal_code": "141411453"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 E MAIN ST STE 301",
            "city": "SPRINGVILLE",
            "state": "NY",
            "postal_code": "141411453",
            "telephone_number": "716-592-2832"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "275 Thomas Indian School Dr",
            "address_purpose": "LOCATION",
            "city": "Irving",
            "state": "NY",
            "postal_code": "140819341",
            "country_code": "US",
            "telephone_number": "716-532-5582",
            "fax_number": "716-242-6344",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DEMMERLEY",
        "first_name": "MIKELLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-07",
        "last_updated": "2025-04-21",
        "certification_date": "2025-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "311324",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "06585726",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lisette Anne D'Eon, MD
• Kenneth Dean Richard Dabolt, RPA-C
• Priscilla K Dale, M.D.
• Dalip K. Khurana, M.D., PLLC
• Tammy Lyn Davis
• Gordon Dietz, CRNA
• Crystal Dimmig
• Jessica Domst, MA
• Debra Ehrig, M.D.
• Jennifer Einarsson, LCSWR

• All providers in Springville, NY
• Pediatrics Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.