Healthcare Provider Details

I. General information

NPI: 1356378152
Provider Name (Legal Business Name): AMY A. SUMMERS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DEPARTMENT OF MEDICINE MEDICAL SERVICE GROUP 1873 WESTERN AVE, SUITE 100
ALBANY NY
12203
US

IV. Provider business mailing address

UPSTATE FAMILY & PREVENTIVE MEDICINE 1873 WESTERN AVE, SUITE 100
ALBANY NY
12203
US

V. Phone/Fax

Practice location:
  • Phone: 518-250-4359
  • Fax: 518-250-4678
Mailing address:
  • Phone: 518-250-4359
  • Fax: 518-250-4678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number338755
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN75515
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN288177
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: