Provider Demographics
NPI:1518550771
Name:BARRIE, AMADU TIJAN (NP)
Entity Type:Individual
Prefix:
First Name:AMADU
Middle Name:TIJAN
Last Name:BARRIE
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 RUTH AVE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-2807
Mailing Address - Country:US
Mailing Address - Phone:646-269-5849
Mailing Address - Fax:
Practice Address - Street 1:175 RUTH AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-2807
Practice Address - Country:US
Practice Address - Phone:646-269-5849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-18
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY310081363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health