Provider Demographics
NPI:1720015456
Name:BLASZ, AMANDA ALBRIGHT (PA)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:ALBRIGHT
Last Name:BLASZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:A
Other - Last Name:ALBRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:571 SAINT JOSEPHS BLVD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901-3230
Mailing Address - Country:US
Mailing Address - Phone:607-271-2050
Mailing Address - Fax:
Practice Address - Street 1:45 MUD CREEK RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:PA
Practice Address - Zip Code:16947-9529
Practice Address - Country:US
Practice Address - Phone:570-297-3746
Practice Address - Fax:570-297-5127
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA002775363A00000X
PAMA055112363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA233676YHLYMedicare PIN