Individual
AMANDA O'CONNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
315 GRANT AVE, LAKE KATRINE, NY 12449-5342
(845) 339-2525
(845) 339-2626
Mailing address
315 GRANT AVE, LAKE KATRINE, NY 12449-5342
(845) 339-2525
(845) 339-2626
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
019729
NY
363AS0400X
Surgical Physician Assistant
019729
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02801449
—
NY
Enumeration date
06/15/2016
Last updated
06/21/2022
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