Healthcare Provider Details

I. General information

NPI: 1851086722
Provider Name (Legal Business Name): AMANDA HUANG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2023
Last Update Date: 04/06/2023
Certification Date: 03/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 SLATE CREEK DR APT 3
CHEEKTOWAGA NY
14227-2832
US

IV. Provider business mailing address

130 JENKINS DR
ENGLEWOOD CLIFFS NJ
07632-1602
US

V. Phone/Fax

Practice location:
  • Phone: 551-655-7088
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number026380
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: