Healthcare Provider Details

I. General information

NPI: 1548314743
Provider Name (Legal Business Name): AMY MAYER PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMY LISA EISENBERG RN

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 05/23/2025
Certification Date: 05/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 JAMES ST
SYRACUSE NY
13206-2387
US

IV. Provider business mailing address

3300 JAMES ST
SYRACUSE NY
13206-2387
US

V. Phone/Fax

Practice location:
  • Phone: 315-663-5206
  • Fax:
Mailing address:
  • Phone: 315-663-5206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number463057-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF401298-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: