Provider Demographics
NPI:1366338634
Name:AMARAIZU, LYNDA CHINYERE
Entity type:Individual
Prefix:
First Name:LYNDA
Middle Name:CHINYERE
Last Name:AMARAIZU
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 MILLAY LN
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-4330
Mailing Address - Country:US
Mailing Address - Phone:631-626-4143
Mailing Address - Fax:
Practice Address - Street 1:52 MILLAY LN
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-4330
Practice Address - Country:US
Practice Address - Phone:631-626-4143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-14
Last Update Date:2025-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY357082363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily