Healthcare Provider Details

I. General information

NPI: 1679373518
Provider Name (Legal Business Name): NORTH FORK DEVELOPMENTAL PEDIATRICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2025
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2921 S MERIDIAN RD
MERIDIAN ID
83642-7961
US

IV. Provider business mailing address

1775 W STATE ST # 179
BOISE ID
83702-3924
US

V. Phone/Fax

Practice location:
  • Phone: 847-858-1340
  • Fax:
Mailing address:
  • Phone: 847-858-1340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. AMY FRANCIS
Title or Position: CHIEF MEDICAL OFFICER
Credential: DO
Phone: 847-858-1340