Healthcare Provider Details

I. General information

NPI: 1710866884
Provider Name (Legal Business Name): AMANDEEP KAUR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2025
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 EDNA AVE
BETHPAGE NY
11714-4117
US

IV. Provider business mailing address

6 EDNA AVE
BETHPAGE NY
11714-4117
US

V. Phone/Fax

Practice location:
  • Phone: 917-254-9550
  • Fax: 917-254-9550
Mailing address:
  • Phone: 917-254-9550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number407447
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number407447
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: