Provider Demographics
NPI:1629082425
Name:SECOR, AMY ANNE (NP)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:ANNE
Last Name:SECOR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:AMY
Other - Middle Name:ANNE
Other - Last Name:FRATANGELO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:821 PRE EMPTION RD STE 300
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:NY
Mailing Address - Zip Code:14456-2061
Mailing Address - Country:US
Mailing Address - Phone:315-787-5310
Mailing Address - Fax:315-787-5314
Practice Address - Street 1:17 E GENESEE ST STE 101
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-4112
Practice Address - Country:US
Practice Address - Phone:315-253-5151
Practice Address - Fax:315-253-0841
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3322911207Q00000X
NYF332291-1207RG0100X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01877930Medicaid
NY01877930Medicaid
RA1670Medicare PIN