Healthcare Provider Details

I. General information

NPI: 1063358083
Provider Name (Legal Business Name): JENNY AMOS-AFFUL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 WATERBURY RD
PROSPECT CT
06712-1200
US

IV. Provider business mailing address

20 W MOSHOLU PKWY S APT 14D
BRONX NY
10468-1130
US

V. Phone/Fax

Practice location:
  • Phone: 203-709-5300
  • Fax:
Mailing address:
  • Phone: 929-800-0329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number354011
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: