Healthcare Provider Details

I. General information

NPI: 1336054857
Provider Name (Legal Business Name): AMY IP LAC, DAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 S SYCAMORE ST
NEWTOWN PA
18940-1516
US

IV. Provider business mailing address

37 AQUA DR
HOLLAND PA
18966-1901
US

V. Phone/Fax

Practice location:
  • Phone: 215-313-7950
  • Fax:
Mailing address:
  • Phone: 215-313-7950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAK001535
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: