Provider Demographics
NPI:1588260582
Name:SATHEESKUMAR, AMANDA RUTH (NP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:RUTH
Last Name:SATHEESKUMAR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1363 PINE CT
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-4512
Mailing Address - Country:US
Mailing Address - Phone:516-353-7191
Mailing Address - Fax:
Practice Address - Street 1:1363 PINE CT
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-4512
Practice Address - Country:US
Practice Address - Phone:516-353-7191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-07
Last Update Date:2023-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY309813363AM0700X
NYAG07200135363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical