Healthcare Provider Details

I. General information

NPI: 1982572228
Provider Name (Legal Business Name): AMANDA ORTIZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2025
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 MAINE AVE
ROCKVILLE CENTRE NY
11570-3614
US

IV. Provider business mailing address

15716 28TH AVE
FLUSHING NY
11354-1526
US

V. Phone/Fax

Practice location:
  • Phone: 516-536-7730
  • Fax:
Mailing address:
  • Phone: 917-617-0589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: