Healthcare Provider Details

I. General information

NPI: 1013470350
Provider Name (Legal Business Name): AMY KOTARSKI DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2019
Last Update Date: 03/06/2024
Certification Date: 03/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3055 SOUTHWESTERN BLVD STE 110
ORCHARD PARK NY
14127-1231
US

IV. Provider business mailing address

3055 SOUTHWESTERN BLVD STE 110
ORCHARD PARK NY
14127-1231
US

V. Phone/Fax

Practice location:
  • Phone: 716-903-6036
  • Fax: 716-463-2225
Mailing address:
  • Phone: 716-903-6036
  • Fax: 716-463-2225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number402713
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number690234
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: