Provider Demographics
NPI:1861646440
Name:VANEVERA, AMY L
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:L
Last Name:VANEVERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2360 COUNTY HIGHWAY 107
Mailing Address - Street 2:
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010-6228
Mailing Address - Country:US
Mailing Address - Phone:518-212-2692
Mailing Address - Fax:
Practice Address - Street 1:2360 COUNTY HIGHWAY 107
Practice Address - Street 2:
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-6228
Practice Address - Country:US
Practice Address - Phone:518-212-2692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-10
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020779-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist