Healthcare Provider Details

I. General information

NPI: 1851759872
Provider Name (Legal Business Name): STEPHANIE AMDUR-CLARK NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2016
Last Update Date: 07/03/2023
Certification Date:
Deactivation Date: 09/10/2019
Reactivation Date: 09/30/2019

III. Provider practice location address

601 ELMWOOD AVE
ROCHESTER NY
14642-2548
US

IV. Provider business mailing address

151 TIMBER CV APT D
WEBSTER NY
14580-3100
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-7520
  • Fax:
Mailing address:
  • Phone: 716-548-1258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN2299120
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number383057
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: