Provider Demographics
NPI:1407720469
Name:SATHASIVAM, AMRIETAA (AUD)
Entity type:Individual
Prefix:
First Name:AMRIETAA
Middle Name:
Last Name:SATHASIVAM
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 COLUMBIA CIR STE 202
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-5163
Mailing Address - Country:US
Mailing Address - Phone:518-690-2060
Mailing Address - Fax:518-690-7111
Practice Address - Street 1:14 COLUMBIA CIR STE 202
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-5163
Practice Address - Country:US
Practice Address - Phone:518-690-2060
Practice Address - Fax:518-690-7111
Is Sole Proprietor?:No
Enumeration Date:2025-10-02
Last Update Date:2025-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY14000081722237700000X
NY003342231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist