Individual
AMANDA MACKILLOP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
54655 MAIN RD, SOUTHOLD, NY 11971-4769
(631) 301-2271
(631) 212-0482
Mailing address
54655 MAIN RD, SOUTHOLD, NY 11971-4769
(631) 301-2271
(631) 212-0482
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
780342
NY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
403484
NY
Other
Enumeration date
11/13/2019
Last updated
12/17/2025
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