Individual
AMANDA CONNELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
13 THOMPSON HAY PATH, SETAUKET, NY 11733-1317
(631) 751-0197
Mailing address
27 CHERYL DR, SHOREHAM, NY 11786-2356
(631) 294-4348
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
03/15/2014
Last updated
03/15/2014
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