Healthcare Provider Details

I. General information

NPI: 1144986290
Provider Name (Legal Business Name): AMANDA FUNICIELLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2021
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89 CLARE ST
BUFFALO NY
14206-2020
US

IV. Provider business mailing address

4380 MAIN ST
AMHERST NY
14226-3544
US

V. Phone/Fax

Practice location:
  • Phone: 716-415-2302
  • Fax:
Mailing address:
  • Phone: 800-462-7652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number132416
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: