Healthcare Provider Details

I. General information

NPI: 1992618508
Provider Name (Legal Business Name): AMY L SPIZUOCO DO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 LIBERTY SQUARE MALL
STONY POINT NY
10980-2400
US

IV. Provider business mailing address

53 GILMORE DR
STONY POINT NY
10980-1045
US

V. Phone/Fax

Practice location:
  • Phone: 617-610-3305
  • Fax:
Mailing address:
  • Phone: 617-610-3305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: AMI DALAL
Title or Position: MANAGING EMPLOYEE
Credential: PA-C
Phone: 617-610-3305