Provider Demographics
NPI:1467934547
Name:BOCTOR, AMANDA M (MS)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:M
Last Name:BOCTOR
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 SYCAMORE CT
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND MILLS
Mailing Address - State:NY
Mailing Address - Zip Code:10930-2811
Mailing Address - Country:US
Mailing Address - Phone:973-517-7176
Mailing Address - Fax:
Practice Address - Street 1:199 KINGS HWY
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:NY
Practice Address - Zip Code:10990-3678
Practice Address - Country:US
Practice Address - Phone:845-243-3133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist