Provider Demographics
NPI:1205384187
Name:KERBEIN, AMANDA
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:
Last Name:KERBEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:K
Other - Last Name:CONNOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 N MOHAWK ST
Mailing Address - Street 2:APT 123
Mailing Address - City:COHOES
Mailing Address - State:NY
Mailing Address - Zip Code:12047-1751
Mailing Address - Country:US
Mailing Address - Phone:518-926-9212
Mailing Address - Fax:
Practice Address - Street 1:1477 SOUTH SCHODACK ROAD
Practice Address - Street 2:
Practice Address - City:CASTLETON ON HUDSON
Practice Address - State:NY
Practice Address - Zip Code:12033-1708
Practice Address - Country:US
Practice Address - Phone:518-477-7103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-20
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program