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General NPI Number Information
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NPI Number | 1568973618
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Entity Type | Individual
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Provider Name | AMANDA TRACY RIVERA PMHNP
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Gender | Female
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Dates
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Enumeration Date | 10/17/2017
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Last Update Date | 03/16/2020
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Provider Practice Location Address
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Address Line | 701 SENECA ST STE 646C
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City | BUFFALO
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State | NY
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Zip | 14210-1351
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Country | US
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Telephone | 716-995-4450
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Fax |
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Provider Business Mailing Address
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Address Line | 171 BROOKS AVE
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City | ROCHESTER
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State | NY
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Zip | 14619-2455
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Country | US
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Telephone |
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | F402924
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | 676126
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License Number State | NY
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