Healthcare Provider Details

I. General information

NPI: 1962148221
Provider Name (Legal Business Name): AMANDA LOVE CAO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2022
Last Update Date: 05/10/2022
Certification Date: 05/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 DRYDEN CT
STATEN ISLAND NY
10302-2603
US

IV. Provider business mailing address

32 DRYDEN CT
STATEN ISLAND NY
10302-2603
US

V. Phone/Fax

Practice location:
  • Phone: 347-309-1207
  • Fax:
Mailing address:
  • Phone: 347-309-1207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number343588
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: