Provider Demographics
NPI:1306025960
Name:ROBERSON, AMY LM (RPA-C)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LM
Last Name:ROBERSON
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:LEIGH
Other - Last Name:MONFILETTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPA-C
Mailing Address - Street 1:2758 ONEIDA ST
Mailing Address - Street 2:
Mailing Address - City:SAUQUOIT
Mailing Address - State:NY
Mailing Address - Zip Code:13456-3108
Mailing Address - Country:US
Mailing Address - Phone:315-323-0866
Mailing Address - Fax:
Practice Address - Street 1:1522 OLD BURRSTONE RD
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-4804
Practice Address - Country:US
Practice Address - Phone:315-797-2450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-31
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012124-1363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical