Most Relevant Information
Provider Data
| NPI Number: | 1003421066 |
| Provider Name: | AMANTHA THEODORE |
| Entity Type: | Individual |
| Taxonomy Code: | 363LF0000X |
| Specialty: | Nurse Practitioner |
| License Number: | RN9364653 |
Most Important Dates
| Enumeration Date: | 09/15/2020 |
| Last Updated: | 09/15/2020 |
Provider Practice Location
531 E LINCOLN AVE APT 4N
MOUNT VERNON
NY
105523743
Practice Location Phone/Fax
| Phone: | 7189209000 |
| Fax: |
Provider Mailing Location
531 E LINCOLN AVE APT 4N
MOUNT VERNON
NY
105523743
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |