Provider Demographics
NPI:1750653028
Name:GUAGLIARDO, AMY DAWN (PTA,LPN)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:DAWN
Last Name:GUAGLIARDO
Suffix:
Gender:F
Credentials:PTA,LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:469 W UNION ST
Mailing Address - Street 2:N/A
Mailing Address - City:NEWARK
Mailing Address - State:NY
Mailing Address - Zip Code:14513-1316
Mailing Address - Country:US
Mailing Address - Phone:585-683-7775
Mailing Address - Fax:
Practice Address - Street 1:1527 KENYON RD
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:NY
Practice Address - Zip Code:14519-8880
Practice Address - Country:US
Practice Address - Phone:716-392-8504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-02
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002069-1171W00000X
NY324571-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No171W00000XOther Service ProvidersContractor