Individual
MISS AMANDA LYN EVANGELISTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
34 MILL ST, PATCHOGUE, NY 11772-1045
(631) 258-2404
Mailing address
34 MILL ST, PATCHOGUE, NY 11772-1045
(631) 258-2404
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
020210
NY
Other
Enumeration date
10/05/2016
Last updated
10/05/2016
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