Healthcare Provider Details

I. General information

NPI: 1417375981
Provider Name (Legal Business Name): AMANDA HOLLERAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA MOYER

II. Dates (important events)

Enumeration Date: 04/02/2014
Last Update Date: 07/22/2023
Certification Date: 10/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 LAC DE VILLE BLVD BLDG D
ROCHESTER NY
14618-5647
US

IV. Provider business mailing address

601 ELMWOOD AVE BOX 6665
ROCHESTER NY
14642-0001
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-5321
  • Fax:
Mailing address:
  • Phone: 585-275-5321
  • Fax: 585-276-1202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License NumberBF4323200B29
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License NumberMD470840
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number319852
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number319852
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: