Individual
AMANDA NOELE PERILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1 POST OFFICE SQ, BOSTON, MA 02109-2106
(917) 241-4414
Mailing address
1 LIBERTY PLZ STE 301, NEW YORK, NY 10006-1404
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA5609
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05724048
—
MS
05
—
23796969
—
LA
Enumeration date
05/01/2013
Last updated
02/27/2024
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