Provider Demographics
NPI:1821686403
Name:WIEGAND, AMY VIRGINIA (MS)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:VIRGINIA
Last Name:WIEGAND
Suffix:
Gender:
Credentials:MS
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:VIRGINIA
Other - Last Name:KILLIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19 APPALACHIAN E
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL JUNCTION
Mailing Address - State:NY
Mailing Address - Zip Code:12533-6709
Mailing Address - Country:US
Mailing Address - Phone:203-885-5996
Mailing Address - Fax:
Practice Address - Street 1:330 ORCHARD ST STE 107
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-4430
Practice Address - Country:US
Practice Address - Phone:203-200-4362
Practice Address - Fax:203-200-1362
Is Sole Proprietor?:No
Enumeration Date:2021-01-08
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIGC00189170300000X
CT168170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS