=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891678371
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMAVI MEDICAL PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/30/2025
-----------------------------------------------------
Last Update Date | 08/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18 E 41ST ST # 1533
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10017-6222
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 934-300-5506
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 140 BERKELEY PL APT 1
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11217-3968
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-756-2312
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. LYNNEA VILLANOVA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 917-756-2312
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------