Provider Demographics
NPI:1689002396
Name:ROSS, AMELIA (MS, LAC)
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:
Last Name:ROSS
Suffix:
Gender:F
Credentials:MS, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:294 BRONXVILLE RD
Mailing Address - Street 2:APT 1F
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708-2850
Mailing Address - Country:US
Mailing Address - Phone:718-551-5228
Mailing Address - Fax:
Practice Address - Street 1:294 BRONXVILLE RD
Practice Address - Street 2:APT 1F
Practice Address - City:BRONXVILLE
Practice Address - State:NY
Practice Address - Zip Code:10708-2850
Practice Address - Country:US
Practice Address - Phone:718-551-5228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-16
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003319171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist