Provider Demographics
NPI:1164850178
Name:AMPUJA, AMY A (NP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:A
Last Name:AMPUJA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:SHARMA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:47 EDMAR RD
Mailing Address - Street 2:
Mailing Address - City:EAST FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02536-4633
Mailing Address - Country:US
Mailing Address - Phone:207-332-9590
Mailing Address - Fax:
Practice Address - Street 1:47 EDMAR RD
Practice Address - Street 2:
Practice Address - City:EAST FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02536
Practice Address - Country:US
Practice Address - Phone:207-332-9590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-30
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005565363LA2200X
MECNP151186363LA2200X
MARN2300488363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health