Individual
AMANDA M. TREVICANO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
221 BEACH 136TH ST, BELLE HARBOR, NY 11694-1323
(917) 440-6779
Mailing address
221 BEACH 136TH ST, BELLE HARBOR, NY 11694-1323
(917) 440-6779
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
026537
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/08/2016
Last updated
03/31/2017
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