Provider Demographics
NPI:1841971520
Name:STAUBITZ, AMANDA ELLE
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:ELLE
Last Name:STAUBITZ
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 1:276 FIFTH AVENUE SUITE 704
Mailing Address - Street 2:PMB 70208
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-1000
Mailing Address - Country:US
Mailing Address - Phone:516-615-1826
Mailing Address - Fax:
Practice Address - Street 1:276 FIFTH AVENUE SUITE 704
Practice Address - Street 2:PMB 70208
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-1000
Practice Address - Country:US
Practice Address - Phone:631-904-7173
Practice Address - Fax:516-241-1194
Is Sole Proprietor?:No
Enumeration Date:2023-07-26
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY405216363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health