Provider Demographics
NPI:1770276024
Name:SGAMBATI, AMANDA NICOLE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:NICOLE
Last Name:SGAMBATI
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68A SELVIN LOOP
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10303-1887
Mailing Address - Country:US
Mailing Address - Phone:347-419-0922
Mailing Address - Fax:
Practice Address - Street 1:68A SELVIN LOOP
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10303-1887
Practice Address - Country:US
Practice Address - Phone:347-419-0922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-01
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033124235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist