Healthcare Provider Details

I. General information

NPI: 1649032665
Provider Name (Legal Business Name): AMANDA LEONA SEALE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2024
Last Update Date: 07/31/2024
Certification Date: 07/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3030 WESTCHESTER AVE STE 305
PURCHASE NY
10577-2574
US

IV. Provider business mailing address

1345 AVENUE OF THE AMERICAS FL 8
NEW YORK NY
10105-0018
US

V. Phone/Fax

Practice location:
  • Phone: 914-848-8630
  • Fax: 914-848-8631
Mailing address:
  • Phone: 908-588-3635
  • Fax: 908-934-9350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number031886
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: