Provider Demographics
NPI:1518763200
Name:FUSCO, AMANDA ANGELINA (MS)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:ANGELINA
Last Name:FUSCO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 KELLY ROAD
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:NY
Mailing Address - Zip Code:10512-2424
Mailing Address - Country:US
Mailing Address - Phone:718-561-9695
Mailing Address - Fax:
Practice Address - Street 1:32 KELLY ROAD
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:NY
Practice Address - Zip Code:10512-2424
Practice Address - Country:US
Practice Address - Phone:718-561-9695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-22
Last Update Date:2025-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency