Healthcare Provider Details

I. General information

NPI: 1124841333
Provider Name (Legal Business Name): AMY NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2024
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1027 46TH AVE STE 301
LONG ISLAND CITY NY
11101-5202
US

IV. Provider business mailing address

6503 W GOULD DR
LITTLETON CO
80123-5138
US

V. Phone/Fax

Practice location:
  • Phone: 720-285-5505
  • Fax:
Mailing address:
  • Phone: 720-285-5505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number036591
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: