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General NPI Number Information
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NPI Number | 1194609768
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Entity Type | Individual
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Provider Name | AMANDA DRISCOLL
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Gender | Female
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Dates
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Enumeration Date | 08/05/2025
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Last Update Date | 08/05/2025
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Provider Practice Location Address
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Address Line | 265 BROADHOLLOW RD
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City | MELVILLE
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State | NY
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Zip | 11747-4833
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Country | US
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Telephone | 631-450-2353
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Fax |
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Provider Business Mailing Address
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Address Line | 26 FAIRWAY LN
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City | RONKONKOMA
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State | NY
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Zip | 11779-6129
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Country | US
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Telephone | 631-521-5497
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WS0200X
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Taxonomy Name | School Registered Nurse
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License Number | 769098
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 163WM0705X
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Taxonomy Name | Medical-Surgical Registered Nurse
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License Number | 769098
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License Number State | NY
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