Healthcare Provider Details

I. General information

NPI: 1346938651
Provider Name (Legal Business Name): AMALIA BECKETT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2023
Last Update Date: 08/01/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 PARK AVE S
NEW YORK NY
10003-1603
US

IV. Provider business mailing address

215 PARK AVE S
NEW YORK NY
10003-1603
US

V. Phone/Fax

Practice location:
  • Phone: 646-602-8237
  • Fax:
Mailing address:
  • Phone: 646-602-8237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF350366
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: