Individual
AMBER DISTAFANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
159 CARLETON AVE, CENTRAL ISLIP, NY 11722-4172
(650) 250-2087
Mailing address
159 CARLETON AVE, CENTRAL ISLIP, NY 11722-4172
(650) 250-2087
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
674452
NY
Other
Enumeration date
05/07/2020
Last updated
05/07/2020
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