Provider Demographics
NPI:1134917834
Name:FEY, AMANDA
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:FEY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1521 CODDINGTON RD
Mailing Address - Street 2:
Mailing Address - City:BROOKTONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:14817-9761
Mailing Address - Country:US
Mailing Address - Phone:607-351-1727
Mailing Address - Fax:
Practice Address - Street 1:31 ADAMS AVE STE 4
Practice Address - Street 2:
Practice Address - City:ENDICOTT
Practice Address - State:NY
Practice Address - Zip Code:13760-5501
Practice Address - Country:US
Practice Address - Phone:607-729-0591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1455175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath