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NPI Code Detail

MEDICARE: MRS. LISETTE AMEDEE PA

MEDICARE: MRS. LISETTE AMEDEE PA
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
1363A00000XPhysician Assistant04118NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
104118OTHERNYLICENSE

General Provider Information

NPI Number : 1841337987
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LISETTE AMEDEE PA
Provider Business Mailing Address
First Line : 345 SCHERMERHORN ST
Second Line :
City : BROOKLYN
State : NY
Zip : 11217-1025
Country : US
Telephone Number : 718-403-3547
Fax Number : 718-858-0145
Provider Business Practice Location Address
First Line : 345 SCHERMERHORN ST
Second Line :
City : BROOKLYN
State : NY
Zip : 11217-1025
Country : US
Telephone Number : 718-403-3547
Fax Number : 718-858-0145
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/30/2007
Last Update Date : 07/08/2007

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Directions to “ MRS. LISETTE AMEDEE PA” Practice Location

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