Healthcare Provider Details

I. General information

NPI: 1922619899
Provider Name (Legal Business Name): AMANDA BUZZITTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2020
Last Update Date: 03/28/2025
Certification Date: 03/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2352 LOUIS KOSSUTH AVE
RONKONKOMA NY
11779-6325
US

IV. Provider business mailing address

2352 LOUIS KOSSUTH AVE
RONKONKOMA NY
11779-6325
US

V. Phone/Fax

Practice location:
  • Phone: 631-873-7338
  • Fax:
Mailing address:
  • Phone: 631-873-7338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number337943-01
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number931923
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: