Provider Demographics
NPI:1225915879
Name:WYGONIK, AMANDA LYNN
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LYNN
Last Name:WYGONIK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 HIDDEN ACRES PATH
Mailing Address - Street 2:
Mailing Address - City:WADING RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:11792-2213
Mailing Address - Country:US
Mailing Address - Phone:631-681-7853
Mailing Address - Fax:
Practice Address - Street 1:260 MIDDLE COUNTRY RD
Practice Address - Street 2:
Practice Address - City:SELDEN
Practice Address - State:NY
Practice Address - Zip Code:11784-2568
Practice Address - Country:US
Practice Address - Phone:631-696-4371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-18
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054667225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist