Individual
MARYLOU D'AMICO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
739 IRVING AVE, SUITE 300, SYRACUSE, NY 13210-1651
(315) 478-1158
(315) 478-3014
Mailing address
739 IRVING AVE, SUITE 300, SYRACUSE, NY 13210-1651
(315) 478-1158
(315) 478-3014
Taxonomy
Speciality
Code
Description
License number
State
363LX0001X
Obstetrics & Gynecology Nurse Practitioner
Primary
F420579
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
109419
PREFERRED CARE
NY
01
—
P019420579
B/C B/S EXCELLUS
NY
Enumeration date
05/10/2006
Last updated
03/27/2012
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