Healthcare Provider Details

I. General information

NPI: 1740914878
Provider Name (Legal Business Name): AMANDA MERLINO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2022
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 THORN AVE
ORCHARD PARK NY
14127-2600
US

IV. Provider business mailing address

9628 KENMORE ST
ANGOLA NY
14006-9461
US

V. Phone/Fax

Practice location:
  • Phone: 716-225-4665
  • Fax:
Mailing address:
  • Phone: 716-225-4665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number404225
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: