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General NPI Number Information
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NPI Number | 1518773795
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Entity Type | Individual
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Provider Name | AMANDA MARIE MEDINA RIVERA RN
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Gender | Female
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Dates
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Enumeration Date | 12/03/2024
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 75 NEW SCOTLAND AVE
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City | ALBANY
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State | NY
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Zip | 12208-3409
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Country | US
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Telephone | 518-549-6616
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Fax |
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Provider Business Mailing Address
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Address Line | 371 1ST ST
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City | TROY
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State | NY
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Zip | 12180-5302
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Country | US
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Telephone | 787-692-5889
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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 | 163WP0809X
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Taxonomy Name | Adult Psychiatric/Mental Health Registered Nurse
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License Number | 945341
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License Number State | NY
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