Provider Demographics
NPI:1417383522
Name:ESPOSITO, AMANDA VICTORIA
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:VICTORIA
Last Name:ESPOSITO
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 1:15720 17TH RD
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-3231
Mailing Address - Country:US
Mailing Address - Phone:917-485-3013
Mailing Address - Fax:
Practice Address - Street 1:15720 17TH RD
Practice Address - Street 2:
Practice Address - City:WHITESTONE
Practice Address - State:NY
Practice Address - Zip Code:11357-3231
Practice Address - Country:US
Practice Address - Phone:917-485-3013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-20
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY746992131174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist