Individual
MS. AMANDA MARIE FORMATO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C, ATC
Contact information
Practice address
4295 HEMPSTEAD TPKE, BETHPAGE, NY 11714-5713
(516) 579-6000
Mailing address
3868 GREEN PL, BETHPAGE, NY 11714-4208
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
—
—
363AS0400X
Surgical Physician Assistant
Primary
PA56656
CA
Other
Enumeration date
01/07/2019
Last updated
03/27/2026
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