Healthcare Provider Details

I. General information

NPI: 1225806425
Provider Name (Legal Business Name): AMANDA TERESE ZETAH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2023
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 EMPIRE BLVD STE 200
WEBSTER NY
14580-1957
US

IV. Provider business mailing address

100 KINGS HWY S
ROCHESTER NY
14617-5504
US

V. Phone/Fax

Practice location:
  • Phone: 585-922-0374
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number002399
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: