Provider Demographics
NPI:1154668572
Name:GROFF, AMANDA M (TSSLD)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:M
Last Name:GROFF
Suffix:
Gender:F
Credentials:TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4479 FREER HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:WALTON
Mailing Address - State:NY
Mailing Address - Zip Code:13856-4568
Mailing Address - Country:US
Mailing Address - Phone:607-435-3129
Mailing Address - Fax:
Practice Address - Street 1:4479 FREER HOLLOW RD
Practice Address - Street 2:
Practice Address - City:WALTON
Practice Address - State:NY
Practice Address - Zip Code:13856-4568
Practice Address - Country:US
Practice Address - Phone:607-435-3129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-04
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY693379121174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist