Individual
MS. AMANDA LYNN RICHARDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7000 AUSTIN ST STE 200, FOREST HILLS, NY 11375-4739
(718) 762-7633
(718) 886-8694
Mailing address
27 UNION ST, PORT JEFFERSON STATION, NY 11776-1251
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
06/11/2016
Last updated
06/11/2016
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