Healthcare Provider Details

I. General information

NPI: 1326893744
Provider Name (Legal Business Name): AMANDA GUILLAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2024
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2094 ALBANY POST RD
MONTROSE NY
10548-1454
US

IV. Provider business mailing address

87 CREAMERY DR
NEW WINDSOR NY
12553-8024
US

V. Phone/Fax

Practice location:
  • Phone: 914-737-4400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number355802
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number796729
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: