Individual
AMANDA GRACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
450 LAKEVILLE RD, NEW HYDE PARK, NY 11042-1118
(516) 734-8500
Mailing address
450 LAKEVILLE RD, NEW HYDE PARK, NY 11042-1118
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
355175
NY
Other
Enumeration date
03/13/2025
Last updated
03/13/2025
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