MEDICARE: AMANDA BUZZITTA

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	164W00000X	Licensed Practical Nurse	337943-01	NY
2	163W00000X	Registered Nurse	931923	NY

General Provider Information

NPI Number	:	1922619899
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA BUZZITTA

Provider Business Mailing Address
First Line	:	2352 LOUIS KOSSUTH AVE
Second Line	:
City	:	RONKONKOMA
State	:	NY
Zip	:	11779-6325
Country	:	US
Telephone Number	:	631-873-7338
Fax Number	:

Provider Business Practice Location Address
First Line	:	2352 LOUIS KOSSUTH AVE
Second Line	:
City	:	RONKONKOMA
State	:	NY
Zip	:	11779-6325
Country	:	US
Telephone Number	:	631-873-7338
Fax Number	:

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

Provider Enumeration Date	:	08/13/2020
Last Update Date	:	03/28/2025

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Directions to “ AMANDA BUZZITTA ” Practice Location

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