Provider Demographics
NPI:1881184869
Name:MASTROPIETRO, AMANDA ROSE (MSED C-F, SLP)
Entity type:Individual
Prefix:MISS
First Name:AMANDA ROSE
Middle Name:
Last Name:MASTROPIETRO
Suffix:
Gender:F
Credentials:MSED C-F, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 FLAT ROCK RD
Mailing Address - Street 2:
Mailing Address - City:LAKE GEORGE
Mailing Address - State:NY
Mailing Address - Zip Code:12845-6911
Mailing Address - Country:US
Mailing Address - Phone:914-275-6321
Mailing Address - Fax:
Practice Address - Street 1:12225 GREENVILLE AVE STE 600
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-9362
Practice Address - Country:US
Practice Address - Phone:214-865-8120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-15
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist