Provider Demographics
NPI:1962902049
Name:SAVAGE, AMANDA SHARA
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:SHARA
Last Name:SAVAGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:SHARA
Other - Last Name:SAVAGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19 N CLINTON AVE UNIT 301
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-7829
Mailing Address - Country:US
Mailing Address - Phone:516-382-0874
Mailing Address - Fax:
Practice Address - Street 1:19 N CLINTON AVE UNIT 301
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-7829
Practice Address - Country:US
Practice Address - Phone:516-382-0874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-15
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst