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Individual

AMY K SOUFFRANT

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
7000 AUSTIN ST STE 200, FOREST HILLS, NY 11375-4739
(718) 762-7633
Mailing address
170 COCHRAN PL, VALLEY STREAM, NY 11581-2960
(347) 513-3349

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
537544111
NY

Other

Enumeration date
10/03/2014
Last updated
10/03/2014
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