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General NPI Number Information
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NPI Number | 1851759872
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Entity Type | Individual
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Provider Name | STEPHANIE AMDUR-CLARK NP
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Gender | Female
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Dates
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Enumeration Date | 02/04/2016
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Last Update Date | 07/03/2023
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Provider Practice Location Address
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Address Line | 601 ELMWOOD AVE
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City | ROCHESTER
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State | NY
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Zip | 14642-2548
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Country | US
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Telephone | 585-275-7520
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Fax |
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Provider Business Mailing Address
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Address Line | 151 TIMBER CV APT D
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City | WEBSTER
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State | NY
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Zip | 14580-3100
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Country | US
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Telephone | 716-548-1258
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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 | 163WH0200X
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Taxonomy Name | Home Health Registered Nurse
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License Number | RN2299120
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 383057
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License Number State | NY
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