Provider Demographics
NPI:1508627456
Name:GREEN, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:GREEN
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 1:33 SUNSET CIR
Mailing Address - Street 2:
Mailing Address - City:SANDY CREEK
Mailing Address - State:NY
Mailing Address - Zip Code:13145-3138
Mailing Address - Country:US
Mailing Address - Phone:315-532-3166
Mailing Address - Fax:
Practice Address - Street 1:33 SUNSET CIR
Practice Address - Street 2:
Practice Address - City:SANDY CREEK
Practice Address - State:NY
Practice Address - Zip Code:13145-3138
Practice Address - Country:US
Practice Address - Phone:315-532-3166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty