Healthcare Provider Details

I. General information

NPI: 1114155637
Provider Name (Legal Business Name): AMY L GUCCIONE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY L SHIH DDS

II. Dates (important events)

Enumeration Date: 06/23/2009
Last Update Date: 01/30/2020
Certification Date: 01/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 POPHAM RD
SCARSDALE NY
10583-4134
US

IV. Provider business mailing address

88 LAKE AVE APT 3D
TUCKAHOE NY
10707-3940
US

V. Phone/Fax

Practice location:
  • Phone: 914-725-7100
  • Fax:
Mailing address:
  • Phone: 347-724-4422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number051031-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number051031-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number051031
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: