Provider Demographics
NPI:1235791138
Name:FINNERTY, AMANDA MAE (PA)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:MAE
Last Name:FINNERTY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 PARK LANE RD STE A202
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06776-2445
Mailing Address - Country:US
Mailing Address - Phone:860-354-9321
Mailing Address - Fax:
Practice Address - Street 1:120 PARK LANE RD STE A202
Practice Address - Street 2:
Practice Address - City:NEW MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06776-2445
Practice Address - Country:US
Practice Address - Phone:860-354-9321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-01
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023545363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT6016OtherCT LICENSE
NY023545OtherNYS LICENSE