Healthcare Provider Details

I. General information

NPI: 1164833992
Provider Name (Legal Business Name): AMANDA LEE RINALDI RPA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2014
Last Update Date: 03/28/2022
Certification Date: 03/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

656 ELMWOOD AVE
BUFFALO NY
14222-1836
US

IV. Provider business mailing address

656 ELMWOOD AVE
BUFFALO NY
14222-1836
US

V. Phone/Fax

Practice location:
  • Phone: 716-883-0515
  • Fax: 716-883-8764
Mailing address:
  • Phone: 716-883-0515
  • Fax: 716-883-8764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number017480-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: