MEDICARE: DR. AMANDA M CRYAN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	052008	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467509240
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMANDA M CRYAN DDS

Provider Business Mailing Address
First Line	:	6501 TRANSIT RD
Second Line	:	SUITE B
City	:	EAST AMHERST
State	:	NY
Zip	:	14051-1427
Country	:	US
Telephone Number	:	716-580-3580
Fax Number	:	716-580-3580

Provider Business Practice Location Address
First Line	:	6501 TRANSIT RD
Second Line	:	SUITE B
City	:	EAST AMHERST
State	:	NY
Zip	:	14051-1427
Country	:	US
Telephone Number	:	716-580-3580
Fax Number	:	716-580-3580

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	07/21/2008

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