Provider Demographics
NPI:1346607595
Name:KENDT, AMANDA (RN)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:KENDT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5223 TELLIER RD
Mailing Address - Street 2:APARTMENT 3
Mailing Address - City:NEWARK
Mailing Address - State:NY
Mailing Address - Zip Code:14513-9516
Mailing Address - Country:US
Mailing Address - Phone:315-651-9070
Mailing Address - Fax:
Practice Address - Street 1:5223 TELLIER RD
Practice Address - Street 2:APARTMENT 3
Practice Address - City:NEWARK
Practice Address - State:NY
Practice Address - Zip Code:14513-9516
Practice Address - Country:US
Practice Address - Phone:315-651-9070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-19
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY656505-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse