Provider Demographics
NPI:1437561933
Name:STEWART, AMY E (MS)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:E
Last Name:STEWART
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MRS
Other - First Name:AMY
Other - Middle Name:E
Other - Last Name:TERPENING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS
Mailing Address - Street 1:3039 VILLAGE BLVD S
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-3604
Mailing Address - Country:US
Mailing Address - Phone:716-359-3214
Mailing Address - Fax:
Practice Address - Street 1:171 INTREPID LN
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13205-2548
Practice Address - Country:US
Practice Address - Phone:315-437-4689
Practice Address - Fax:315-437-4698
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-02
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1079595174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist