Healthcare Provider Details

I. General information

NPI: 1417356528
Provider Name (Legal Business Name): AMANDA ROSE WALSH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2014
Last Update Date: 08/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 W 90TH ST APT B
NEW YORK NY
10024-1549
US

IV. Provider business mailing address

36 W 90TH ST APT B
NEW YORK NY
10024-1549
US

V. Phone/Fax

Practice location:
  • Phone: 347-452-4198
  • Fax:
Mailing address:
  • Phone: 347-452-4198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: