Provider Demographics
NPI:1003613522
Name:DENNIS, AMANDA LEE
Entity type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:LEE
Last Name:DENNIS
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:AMANDA
Other - Middle Name:LEE
Other - Last Name:IACHETTA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:13 LUZERNE PL
Mailing Address - Street 2:
Mailing Address - City:HADLEY
Mailing Address - State:NY
Mailing Address - Zip Code:12835-1841
Mailing Address - Country:US
Mailing Address - Phone:518-207-6308
Mailing Address - Fax:
Practice Address - Street 1:13 LUZERNE PL
Practice Address - Street 2:
Practice Address - City:HADLEY
Practice Address - State:NY
Practice Address - Zip Code:12835-1841
Practice Address - Country:US
Practice Address - Phone:518-207-6308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1520284211252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency