Healthcare Provider Details

I. General information

NPI: 1457737280
Provider Name (Legal Business Name): AMANDA DIPIERRO N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2015
Last Update Date: 03/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 PATROON CREEK BLVD SUITE 1
ALBANY NY
12206-5013
US

IV. Provider business mailing address

400 PATROON CREEK BLVD SUITE 1
ALBANY NY
12206-5013
US

V. Phone/Fax

Practice location:
  • Phone: 518-489-0044
  • Fax: 518-489-3591
Mailing address:
  • Phone: 518-489-0044
  • Fax: 518-489-3591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF339652
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: