Healthcare Provider Details

I. General information

NPI: 1982152252
Provider Name (Legal Business Name): AMANDA K MCKALLIP AU.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA K CZECH

II. Dates (important events)

Enumeration Date: 09/15/2016
Last Update Date: 07/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 ELIZABETH BLACKWELL ST SUITE C
GENEVA NY
14456-3403
US

IV. Provider business mailing address

64 ELIZABETH BLACKWELL ST SUITE C
GENEVA NY
14456-3403
US

V. Phone/Fax

Practice location:
  • Phone: 315-789-3595
  • Fax: 315-789-9051
Mailing address:
  • Phone: 315-789-3595
  • Fax: 315-789-9051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number002676
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: