MEDICARE: AMANDA ROSE BOLLINI

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	174400000X	Specialist

General Provider Information

NPI Number	:	1790469286
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA ROSE BOLLINI

Provider Business Mailing Address
First Line	:	650 VICTORY BLVD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10301-3553
Country	:	US
Telephone Number	:	347-613-6145
Fax Number	:

Provider Business Practice Location Address
First Line	:	650 VICTORY BLVD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10301-3553
Country	:	US
Telephone Number	:	347-613-6145
Fax Number	:

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

Provider Enumeration Date	:	06/14/2023
Last Update Date	:	06/14/2023

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Directions to “ AMANDA ROSE BOLLINI ” Practice Location

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