Provider Demographics
NPI:1518344670
Name:WURTZEL, AMANDA YALE
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:YALE
Last Name:WURTZEL
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:AMANDA
Other - Middle Name:YALE
Other - Last Name:CHAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:225 E 95TH ST
Mailing Address - Street 2:APT 29G
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-4000
Mailing Address - Country:US
Mailing Address - Phone:516-455-8601
Mailing Address - Fax:
Practice Address - Street 1:225 E 95TH ST
Practice Address - Street 2:APT 29G
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-4000
Practice Address - Country:US
Practice Address - Phone:516-455-8601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-28
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023375235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist