Provider Demographics
NPI:1760074876
Name:AMOROSO, JOANN (RDH, OMT)
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:
Last Name:AMOROSO
Suffix:
Gender:F
Credentials:RDH, OMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11762-1641
Mailing Address - Country:US
Mailing Address - Phone:516-417-6535
Mailing Address - Fax:
Practice Address - Street 1:350 BROADWAY
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA PARK
Practice Address - State:NY
Practice Address - Zip Code:11762-1641
Practice Address - Country:US
Practice Address - Phone:516-417-6535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-09
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171400000XOther Service ProvidersHealth & Wellness CoachGroup - Single Specialty