Provider Demographics
NPI:1740969906
Name:TANNER PATEL, AMANDA MARIE (NP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARIE
Last Name:TANNER PATEL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:131 E AMES CT
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-2317
Mailing Address - Country:US
Mailing Address - Phone:516-414-6900
Mailing Address - Fax:516-307-8840
Practice Address - Street 1:3333 NEW HYDE PARK RD STE 100101
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1204
Practice Address - Country:US
Practice Address - Phone:516-663-6400
Practice Address - Fax:516-307-8840
Is Sole Proprietor?:No
Enumeration Date:2023-07-14
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYF352354363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily