Healthcare Provider Details

I. General information

NPI: 1679358055
Provider Name (Legal Business Name): MARIANA ROSE AMES FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2023
Last Update Date: 08/25/2023
Certification Date: 08/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6620 FLY RD STE 305
EAST SYRACUSE NY
13057-4205
US

IV. Provider business mailing address

6620 FLY RD
EAST SYRACUSE NY
13057-9791
US

V. Phone/Fax

Practice location:
  • Phone: 315-464-3938
  • Fax: 315-464-5359
Mailing address:
  • Phone: 315-464-4472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF352006-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: