Provider Demographics
NPI:1275762288
Name:AMIDON, CRYSTAL JOY-KARRY
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:JOY-KARRY
Last Name:AMIDON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7719 CANAL ST
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:NY
Mailing Address - Zip Code:14711-8720
Mailing Address - Country:US
Mailing Address - Phone:585-403-6270
Mailing Address - Fax:
Practice Address - Street 1:7719 CANAL ST
Practice Address - Street 2:
Practice Address - City:BELFAST
Practice Address - State:NY
Practice Address - Zip Code:14711-8720
Practice Address - Country:US
Practice Address - Phone:585-403-6270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-11
Last Update Date:2009-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY281773-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse