Healthcare Provider Details

I. General information

NPI: 1083535603
Provider Name (Legal Business Name): AMANDA NICOLE KEANE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 HYLAN BLVD STE 9B1
STATEN ISLAND NY
10305-1945
US

IV. Provider business mailing address

422 ARTHUR KILL RD
STATEN ISLAND NY
10308-1121
US

V. Phone/Fax

Practice location:
  • Phone: 917-397-8947
  • Fax:
Mailing address:
  • Phone: 718-619-9723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: