MEDICARE: AMANDA PAYTON MODY M.S.ED, R.N.

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	163W00000X	Registered Nurse	751566	NY
2	374J00000X	Doula

General Provider Information

NPI Number	:	1740558766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA PAYTON MODY M.S.ED, R.N.

Provider Business Mailing Address
First Line	:	4 FLORENCE AVE
Second Line	:
City	:	BALLSTON LAKE
State	:	NY
Zip	:	12019-2717
Country	:	US
Telephone Number	:	518-577-1222
Fax Number	:

Provider Business Practice Location Address
First Line	:	4 FLORENCE AVE
Second Line	:
City	:	BALLSTON LAKE
State	:	NY
Zip	:	12019-2717
Country	:	US
Telephone Number	:	518-577-1222
Fax Number	:

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

Provider Enumeration Date	:	12/05/2011
Last Update Date	:	10/13/2021

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