Individual
AMANDA WALTUCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
125 N WOOD LN, WOODMERE, NY 11598-2123
(516) 596-8854
Mailing address
125 N WOOD LN, WOODMERE, NY 11598-2123
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0154031
NY
Other
Enumeration date
04/29/2013
Last updated
04/29/2013
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