Healthcare Provider Details

I. General information

NPI: 1831443027
Provider Name (Legal Business Name): AMELIA ANNE CICCARELLI FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2012
Last Update Date: 05/12/2021
Certification Date: 05/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 BURDETT AVE SAMARITAN HOSPITAL
TROY NY
12180-2466
US

IV. Provider business mailing address

5410 MARYLAND WAY SUITE 300, COGENT HMG
BRENTWOOD TN
37027-5064
US

V. Phone/Fax

Practice location:
  • Phone: 518-271-3300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number337301
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: