Provider Demographics
NPI:1811481419
Name:BEHRENS, AMANDA
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:
Last Name:BEHRENS
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 1:83 RIVERSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:MASTIC BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11951-1120
Mailing Address - Country:US
Mailing Address - Phone:631-729-6973
Mailing Address - Fax:
Practice Address - Street 1:83 RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:MASTIC BEACH
Practice Address - State:NY
Practice Address - Zip Code:11951-1120
Practice Address - Country:US
Practice Address - Phone:631-729-6973
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-18
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1232239181174400000X
NY1232240181174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist