Healthcare Provider Details

I. General information

NPI: 1629082425
Provider Name (Legal Business Name): AMY ANNE SECOR NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY ANNE FRATANGELO FNP

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 03/19/2021
Certification Date: 03/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 E GENESEE ST STE 101
AUBURN NY
13021-4112
US

IV. Provider business mailing address

821 PRE EMPTION RD STE 300
GENEVA NY
14456-2061
US

V. Phone/Fax

Practice location:
  • Phone: 315-253-5151
  • Fax: 315-253-0841
Mailing address:
  • Phone: 315-787-5310
  • Fax: 315-787-5314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberF3322911
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberF332291-1
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF332291-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: