MEDICARE: MISS AMANDA L IRIZARRY

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	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1730427790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS AMANDA L IRIZARRY

Provider Business Mailing Address
First Line	:	106 MAGNOLIA DR
Second Line	:
City	:	MASTIC BEACH
State	:	NY
Zip	:	11951-3806
Country	:	US
Telephone Number	:	631-387-1821
Fax Number	:

Provider Business Practice Location Address
First Line	:	805 KENT AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11205-1581
Country	:	US
Telephone Number	:	718-473-3808
Fax Number	:

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

Provider Enumeration Date	:	01/26/2013
Last Update Date	:	01/26/2013

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Directions to “ MISS AMANDA L IRIZARRY ” Practice Location

Language	Start Address	Practice Location

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