Individual provider · NPI-1

Kelly Vanessa Amaya

Nurse Practitioner, Family · Islandia, NY

NPI number1548801020
StatusActive
Last updated in NPPESOct 4, 2019

Details

NPI
1548801020
Entity type
Individual (NPI-1)
Name
Kelly Vanessa Amaya
Sex
Female
Sole proprietor
No
Enumeration date
Oct 4, 2019
Last updated
Oct 4, 2019

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
363LF0000X Nurse Practitioner, Family344697NYYes

Practice location

3001 Expressway Dr N
Islandia, NY 11749-5301

Phone 631-292-6747

Mailing address

815 Commack Rd
Brentwood, NY 11717-7409

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