Healthcare Provider Details

I. General information

NPI: 1487577177
Provider Name (Legal Business Name): AMANDA SCIRICA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 GLEN COVE AVE
GLEN COVE NY
11542-2896
US

IV. Provider business mailing address

37 JUNE AVE
BAYVILLE NY
11709-2336
US

V. Phone/Fax

Practice location:
  • Phone: 516-302-7091
  • Fax:
Mailing address:
  • Phone: 516-302-7091
  • Fax: 516-302-7091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF360103
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: