Individual
AMANDA LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
15 HORSEBLOCK PL, FARMINGVILLE, NY 11738-1204
(631) 854-2554
Mailing address
15 HORSEBLOCK PL, FARMINGVILLE, NY 11738-1204
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
11600464
—
NY
Enumeration date
09/14/2017
Last updated
09/14/2017
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