Individual
MRS. AMANDA SUE LOIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
700 E BRIGHTON AVE, SYRACUSE, NY 13205-2201
(650) 294-0792
Mailing address
700 E BRIGHTON AVE, SYRACUSE, NY 13205-2201
(650) 294-0792
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
018516
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04179062
—
NY
Enumeration date
07/09/2010
Last updated
03/29/2018
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