Provider Demographics
NPI:1942464821
Name:AMOROSO, MARY ALICE (PNP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:ALICE
Last Name:AMOROSO
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 HEDGEROW CIRCLE
Mailing Address - Street 2:
Mailing Address - City:HONEOYE FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14472-9232
Mailing Address - Country:US
Mailing Address - Phone:585-582-2757
Mailing Address - Fax:
Practice Address - Street 1:417 SOUTH AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-1009
Practice Address - Country:US
Practice Address - Phone:585-325-5260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY381550363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics