Individual
AMYLAH HEAVEN DE LA ROSA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
129 MAIN ST UNIT G8, CORNWALL, NY 12518-1529
(516) 493-0030
Mailing address
129 MAIN ST UNIT G8, CORNWALL, NY 12518-1529
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
04/17/2025
Last updated
04/17/2025
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