Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 430453 | NY |
NPI | 1013143882 |
---|---|
Provider Name | Mrs. Amelia Tirado |
First Address | Staten Island, NY 10310-2306 |
Second Address | Staten Island, NY 10310-2306 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2009 |
Last Update Date | 05/06/2009 |