Provider Demographics
NPI:1700261815
Name:PAVIA, AMY (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:PAVIA
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 VANDERBILT AVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06854-3835
Mailing Address - Country:US
Mailing Address - Phone:646-831-0104
Mailing Address - Fax:
Practice Address - Street 1:32 VANDERBILT AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06854-3835
Practice Address - Country:US
Practice Address - Phone:646-831-0104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-30
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT075350163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant