Healthcare Provider Details

I. General information

NPI: 1205667201
Provider Name (Legal Business Name): AMY PANDOZZI RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2024
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

847 JAMES ST
SYRACUSE NY
13203-2504
US

IV. Provider business mailing address

9516 N WOODLAWN DR
BREWERTON NY
13029-9400
US

V. Phone/Fax

Practice location:
  • Phone: 315-492-1184
  • Fax:
Mailing address:
  • Phone: 315-559-5244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number586372
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: