Provider Demographics
NPI:1740654961
Name:BARRY, AMANDA L
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:L
Last Name:BARRY
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 1:44 ORANGE ST
Mailing Address - Street 2:#814
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-3130
Mailing Address - Country:US
Mailing Address - Phone:631-807-9533
Mailing Address - Fax:
Practice Address - Street 1:128 CEDAR AVE
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06705-2700
Practice Address - Country:US
Practice Address - Phone:203-757-9271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-27
Last Update Date:2015-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program