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Individual

MRS. AMANDA DENICOLA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
1138 BROADWAY ST, ELMIRA, NY 14904-2502
(607) 734-2695
(607) 734-2917
Mailing address
571 SAINT JOSEPHS BLVD, FL 2, ELMIRA, NY 14901-3230
(607) 271-2050

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
022806
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
05397571
NY
Enumeration date
10/16/2018
Last updated
11/24/2020
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