Provider Demographics
NPI:1992075329
Name:MALAVE, AMY SUE (ANP, GNP)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:SUE
Last Name:MALAVE
Suffix:
Gender:F
Credentials:ANP, GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CENTER DR
Mailing Address - Street 2:
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-3307
Mailing Address - Country:US
Mailing Address - Phone:631-852-1987
Mailing Address - Fax:631-852-3966
Practice Address - Street 1:100 CENTER DR
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-3307
Practice Address - Country:US
Practice Address - Phone:631-852-1987
Practice Address - Fax:631-852-3966
Is Sole Proprietor?:No
Enumeration Date:2012-01-02
Last Update Date:2012-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF301351-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health