Provider Demographics
NPI:1578929832
Name:NATALICCHIO, AMY (RN MS FNP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:NATALICCHIO
Suffix:
Gender:F
Credentials:RN MS FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 N MAIN ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-4021
Mailing Address - Country:US
Mailing Address - Phone:845-499-2017
Mailing Address - Fax:845-499-2018
Practice Address - Street 1:301 N MAIN ST
Practice Address - Street 2:SUITE #3
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-4021
Practice Address - Country:US
Practice Address - Phone:845-499-2017
Practice Address - Fax:845-499-2018
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-01
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY690180-1261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service