Provider Demographics
NPI:1427530757
Name:DELCORO, AMANDA
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:
Last Name:DELCORO
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 1:6184 MICHAELJON WAY
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:NY
Mailing Address - Zip Code:13039-9389
Mailing Address - Country:US
Mailing Address - Phone:315-877-9859
Mailing Address - Fax:
Practice Address - Street 1:6184 MICHAELJON WAY
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:NY
Practice Address - Zip Code:13039-9389
Practice Address - Country:US
Practice Address - Phone:315-877-9859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-04
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist