Healthcare Provider Details

I. General information

NPI: 1548747967
Provider Name (Legal Business Name): AMANDA MARIE BUZOLICH AGPCNP-BC,OCN,CHPN,
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMANDA MARIE TALMADGE AGPCNP-BC,OCN,CHPN

II. Dates (important events)

Enumeration Date: 07/27/2018
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 MINEOLA BLVD STE 500
MINEOLA NY
11501-4074
US

IV. Provider business mailing address

120 MINEOLA BLVD STE 500
MINEOLA NY
11501-4074
US

V. Phone/Fax

Practice location:
  • Phone: 516-663-9500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number713309-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9300321
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number309947
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: