Healthcare Provider Details

I. General information

NPI: 1952148017
Provider Name (Legal Business Name): MADELINE ROSE AMEDORE FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2024
Last Update Date: 07/15/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 EMPIRE STATE BLVD
CASTLETON NY
12033-9777
US

IV. Provider business mailing address

6 WELLNESS WAY STE 201
LATHAM NY
12110-2156
US

V. Phone/Fax

Practice location:
  • Phone: 518-477-2167
  • Fax: 518-477-5182
Mailing address:
  • Phone: 518-782-3700
  • Fax: 518-782-3799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF354604
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: