Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist |
NPI | 1023296308 |
---|---|
Provider Name | Ms. Amanda R. Desio |
First Address | Kenmore, NY 14217-2331 |
Second Address | Buffalo, NY 14210 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2008 |
Last Update Date | 08/02/2008 |