MEDICARE: AMANDA KIEFEL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	022153	NY

General Provider Information

NPI Number	:	1245523422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA KIEFEL

Provider Business Mailing Address
First Line	:	10 LAKE DR
Second Line	:
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11040-1123
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10 LAKE DR
Second Line	:
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11040-1123
Country	:	US
Telephone Number	:	516-627-6391
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2011
Last Update Date	:	02/05/2015

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Directions to “ AMANDA KIEFEL ” Practice Location

Language	Start Address	Practice Location

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