Individual
AMANDA KRISTINE PHUA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
888 SAYVILLE AVE, BOHEMIA, NY 11716-4318
(631) 839-9944
Mailing address
888 SAYVILLE AVE, BOHEMIA, NY 11716-4318
(631) 839-9944
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
1211549
NY
Other
Enumeration date
07/19/2016
Last updated
07/19/2016
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