Individual
MISS AMANDA NICOLE SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
116 MARIAN DR, SYRACUSE, NY 13219-2423
(315) 569-8872
Mailing address
116 MARIAN DR, SYRACUSE, NY 13219-2423
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
692607121
NY
174400000X
Specialist
692608121
NY
Other
Enumeration date
08/10/2016
Last updated
08/10/2016
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