Healthcare Provider Details

I. General information

NPI: 1356764740
Provider Name (Legal Business Name): AMANDA RAE TALERICO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2014
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

168 CENTRE ST FL 2
NEW YORK NY
10013-6501
US

IV. Provider business mailing address

366 5TH AVE FL 4
NEW YORK NY
10001-2241
US

V. Phone/Fax

Practice location:
  • Phone: 212-966-2178
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number30 306548
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number22 616794
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: