Provider Demographics
NPI:1851409411
Name:NEDOSTUP, AMY E (AUD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:E
Last Name:NEDOSTUP
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3341 BEALE AVE
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601-1549
Mailing Address - Country:US
Mailing Address - Phone:814-944-5357
Mailing Address - Fax:
Practice Address - Street 1:3341 BEALE AVE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-1549
Practice Address - Country:US
Practice Address - Phone:814-944-5357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT006287231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1028287310001Medicaid