Provider Demographics
NPI:1972019842
Name:BUITH, AMANDA L
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:L
Last Name:BUITH
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:AMANDA
Other - Middle Name:L
Other - Last Name:LAMBERTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2 FAIRVIEW LN
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-5408
Mailing Address - Country:US
Mailing Address - Phone:516-330-2672
Mailing Address - Fax:
Practice Address - Street 1:2 FAIRVIEW LN
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-5408
Practice Address - Country:US
Practice Address - Phone:516-330-2672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-14
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007970-1225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant