Provider Demographics
NPI:1427400647
Name:RODRIGUEZ, AMANDA
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:RODRIGUEZ
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 1:2164 BARNES AVE
Mailing Address - Street 2:APT 232
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-1961
Mailing Address - Country:US
Mailing Address - Phone:347-231-7471
Mailing Address - Fax:
Practice Address - Street 1:2164 BARNES AVE
Practice Address - Street 2:APT 232
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-1961
Practice Address - Country:US
Practice Address - Phone:347-231-7471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-12
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency