Provider Demographics
NPI:1720462989
Name:LAKTASH, AMY
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:
Last Name:LAKTASH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 OVERWOOD RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44313-3905
Mailing Address - Country:US
Mailing Address - Phone:330-212-3383
Mailing Address - Fax:
Practice Address - Street 1:148 E 38TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-2607
Practice Address - Country:US
Practice Address - Phone:844-359-8363
Practice Address - Fax:833-955-3592
Is Sole Proprietor?:No
Enumeration Date:2015-07-16
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT10517363LA2200X
NY310734363LA2200X
PASP025815363LA2200X
OHCOA.17597-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health