Healthcare Provider Details

I. General information

NPI: 1760318240
Provider Name (Legal Business Name): AMANDA R RUGGIERI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 LEWIS CT
CHESTER NY
10918-1763
US

IV. Provider business mailing address

20 LEWIS CT
CHESTER NY
10918-1763
US

V. Phone/Fax

Practice location:
  • Phone: 845-774-0697
  • Fax:
Mailing address:
  • Phone: 845-774-0697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: