Individual
AMANDA JESSICA CANDILORO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
121 OAK ST, MEDFORD, NY 11763-4093
(631) 504-2173
Mailing address
121 OAK ST, MEDFORD, NY 11763-4093
(631) 504-2173
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
320196
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
320196
THE STATE EDUCATION DEPARTMENT
NY
Enumeration date
08/06/2017
Last updated
07/21/2022
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