Healthcare Provider Details

I. General information

NPI: 1235577156
Provider Name (Legal Business Name): AMELIA WINTER ATR-BC, LCAT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2013
Last Update Date: 06/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 15TH ST
BROOKLYN NY
11215-4988
US

IV. Provider business mailing address

255 15TH ST
BROOKLYN NY
11215-4988
US

V. Phone/Fax

Practice location:
  • Phone: 718-788-5101
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number001628
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: