Healthcare Provider Details

I. General information

NPI: 1821968017
Provider Name (Legal Business Name): AMY-RUTH ABENA ASAMOAH PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2025
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4335 GRACE AVE
BRONX NY
10466-1862
US

IV. Provider business mailing address

8 BRUCE CT
SUFFERN NY
10901-3321
US

V. Phone/Fax

Practice location:
  • Phone: 917-496-7336
  • Fax:
Mailing address:
  • Phone: 646-934-2614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number407753
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: