Provider Demographics
NPI:1760045918
Name:WALSH, AMANDA RIZZO (MD, MS)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:RIZZO
Last Name:WALSH
Suffix:
Gender:F
Credentials:MD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 BROADHOLLOW RD STE 100
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-3606
Mailing Address - Country:US
Mailing Address - Phone:631-424-3600
Mailing Address - Fax:
Practice Address - Street 1:510 BROADHOLLOW RD STE 100
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-3606
Practice Address - Country:US
Practice Address - Phone:631-424-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-15
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3276122086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery