Individual
MISS AMANDA M TITUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6 REDBUD CT, MIDDLE ISLAND, NY 11953
(631) 745-6798
Mailing address
PO BOX 619, RIDGE, NY 11961
(631) 745-6798
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
3114491
NY
Other
Enumeration date
11/29/2012
Last updated
11/29/2012
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