Basic Information
| Provider Information | |||||||||
| NPI: | 1104572833 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | FUCCI | ||||||||
| FirstName: | AMANDA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2434 WALLEN LN | ||||||||
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| City: | NORTH BELLMORE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117102729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5165321055 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1530 FRONT ST | ||||||||
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| City: | EAST MEADOW | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115542265 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5163247500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2022 | ||||||||
| LastUpdateDate: | 02/22/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | 004361 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.