Provider Demographics
NPI:1063494342
Name:ST AMAND, CARRIE ANN (RPA-C)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:ANN
Last Name:ST AMAND
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 RYKOWSKI LN
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10941-4018
Mailing Address - Country:US
Mailing Address - Phone:845-692-3376
Mailing Address - Fax:845-692-0124
Practice Address - Street 1:28 RYKOWSKI LN
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10941-4018
Practice Address - Country:US
Practice Address - Phone:845-692-3376
Practice Address - Fax:845-692-0124
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007058363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02472939Medicaid
NY0F4782Medicare PIN
NY02472939Medicaid