Provider Demographics
NPI:1972744514
Name:DIZNEY, AMANDA HARRIS (MS CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:HARRIS
Last Name:DIZNEY
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 E 89TH ST APT 4FW
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-2615
Mailing Address - Country:US
Mailing Address - Phone:860-798-3998
Mailing Address - Fax:
Practice Address - Street 1:157 E 89TH ST
Practice Address - Street 2:APT 4FW
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-2617
Practice Address - Country:US
Practice Address - Phone:860-798-3998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-11
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016935235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist