Individual
AMANDA TELESFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
210 SHORE RD, 1F, LONG BEACH, NY 11561-4235
(212) 858-9741
Mailing address
949 E 42ND ST, BROOKLYN, NY 11210-3521
(212) 858-9741
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
319759
NY
Other
Enumeration date
12/30/2014
Last updated
12/30/2014
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