Healthcare Provider Details

I. General information

NPI: 1659204717
Provider Name (Legal Business Name): AMANDA ANN GIUDICE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2026
Last Update Date: 06/06/2026
Certification Date: 06/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 NEDRA PL
STATEN ISLAND NY
10312-1736
US

IV. Provider business mailing address

110 KENNINGTON ST
STATEN ISLAND NY
10308-1723
US

V. Phone/Fax

Practice location:
  • Phone: 718-984-9800
  • Fax:
Mailing address:
  • Phone: 541-310-1207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number14420820
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: