Provider Demographics
NPI:1952701047
Name:ZADERIKO, AMANDA NICOLE (OTR)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:NICOLE
Last Name:ZADERIKO
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:937 VICTORY BLVD
Mailing Address - Street 2:APARTMENT 1G
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-3704
Mailing Address - Country:US
Mailing Address - Phone:646-209-1533
Mailing Address - Fax:
Practice Address - Street 1:937 VICTORY BLVD
Practice Address - Street 2:APARTMENT 1G
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-3704
Practice Address - Country:US
Practice Address - Phone:646-209-1533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-26
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY63 018776225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist