Individual
AMY DANIELLE LARUSSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
90 FAWN LN E, SOUTH SETAUKET, NY 11720-1310
(631) 839-4099
Mailing address
90 FAWN LN E, SOUTH SETAUKET, NY 11720-1310
(631) 839-4099
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
556014-01
NY
Other
Enumeration date
01/15/2025
Last updated
01/15/2025
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