Individual
MS. AMANDA RYDBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
4 FULLER ST, ALEXANDRIA BAY, NY 13607-1391
(315) 482-2511
(315) 482-5553
Mailing address
4 FULLER ST, ALEXANDRIA BAY, NY 13607-1316
(315) 482-2511
(315) 482-5553
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
007079
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002276337
—
NY
Enumeration date
07/17/2006
Last updated
03/18/2024
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