Healthcare Provider Details

I. General information

NPI: 1578720264
Provider Name (Legal Business Name): AMY A MEMMINGER M.S. ED.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2008
Last Update Date: 05/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6248 BALSAM FIR CT
CLARENCE CENTER NY
14032-9150
US

IV. Provider business mailing address

6248 BALSAM FIR COURT
CLARENCE CENTER NY
14032
US

V. Phone/Fax

Practice location:
  • Phone: 716-898-3756
  • Fax:
Mailing address:
  • Phone: 716-898-3756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: