Provider Demographics
NPI:1396239620
Name:OLIVERA, AMY ANN
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:ANN
Last Name:OLIVERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3240 HENRY HUDSON PKWY APT 7F
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-3268
Mailing Address - Country:US
Mailing Address - Phone:347-652-7775
Mailing Address - Fax:
Practice Address - Street 1:3240 HENRY HUDSON PKWY APT 7F
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-3268
Practice Address - Country:US
Practice Address - Phone:347-652-7775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-20
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY898377141174400000X
NY909273151174400000X
NY909271151174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist