Healthcare Provider Details

I. General information

NPI: 1588204390
Provider Name (Legal Business Name): AMANDA MORSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2020
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2809 WEHRLE DR STE 1
BUFFALO NY
14221-7385
US

IV. Provider business mailing address

2809 WEHRLE DR STE 1
BUFFALO NY
14221-7385
US

V. Phone/Fax

Practice location:
  • Phone: 716-277-1027
  • Fax: 716-276-8099
Mailing address:
  • Phone: 716-277-1027
  • Fax: 716-276-8099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number402898
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number693069
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: