Individual
AMANDA SUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
764 BRADY AVE, APT 231, BRONX, NY 10462-2761
(917) 795-3350
Mailing address
764 BRADY AVE, APT 231, BRONX, NY 10462-2761
(917) 795-3350
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
323817-1
NY
Other
Enumeration date
11/28/2015
Last updated
11/28/2015
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