Individual
AMANDA LYNN AGLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
830 WASHINGTON ST, WATERTOWN, NY 13601-4034
(315) 755-3670
(315) 755-3671
Mailing address
830 WASHINGTON ST, WATERTOWN, NY 13601-4034
(315) 755-3670
(315) 755-3671
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
023549
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05967193
—
NY
Enumeration date
06/06/2019
Last updated
02/15/2024
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