Individual
AMANDA HANSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
111 MALTESE DR, MIDDLETOWN, NY 10940-2115
(845) 342-4774
(845) 818-7555
Mailing address
111 MALTESE DR, MIDDLETOWN, NY 10940-2115
(845) 342-4774
(845) 818-7555
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
008330
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
008330
NYS LICENSE
NY
Enumeration date
10/12/2006
Last updated
07/08/2007
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