Healthcare Provider Details

I. General information

NPI: 1497691794
Provider Name (Legal Business Name): AMANDA RENEE KLEIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1682 EMPIRE BLVD
WEBSTER NY
14580-2198
US

IV. Provider business mailing address

936 LITTLE BARDFIELD RD
WEBSTER NY
14580-8932
US

V. Phone/Fax

Practice location:
  • Phone: 585-671-6790
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number356883
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: