Provider Demographics
NPI:1205599206
Name:GAGLIARDO, AMY JEAN (RN)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:JEAN
Last Name:GAGLIARDO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5720 BENNING RD
Mailing Address - Street 2:
Mailing Address - City:WEST FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14170-9754
Mailing Address - Country:US
Mailing Address - Phone:716-345-3218
Mailing Address - Fax:
Practice Address - Street 1:3041 OP RD
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1238
Practice Address - Country:US
Practice Address - Phone:716-345-3218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-16
Last Update Date:2021-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY604852-01163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health