Provider Demographics
NPI:1851587851
Name:AMED, AMANDA NICHOLS (DDS)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:NICHOLS
Last Name:AMED
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 W 57TH ST
Mailing Address - Street 2:STE 1208
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-2831
Mailing Address - Country:US
Mailing Address - Phone:212-904-0277
Mailing Address - Fax:
Practice Address - Street 1:1350 AVENUE OF THE AMERICAS
Practice Address - Street 2:SUITE 2708
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-4702
Practice Address - Country:US
Practice Address - Phone:212-904-0277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-24
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053609122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist