Provider Demographics
NPI:1861765786
Name:AMEYAW, CONSTANCE (LPN)
Entity type:Individual
Prefix:MISS
First Name:CONSTANCE
Middle Name:
Last Name:AMEYAW
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 TUDOR PL
Mailing Address - Street 2:#4A
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10452-8558
Mailing Address - Country:US
Mailing Address - Phone:646-217-9275
Mailing Address - Fax:
Practice Address - Street 1:112 TUDOR PL
Practice Address - Street 2:#4A
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-8558
Practice Address - Country:US
Practice Address - Phone:646-217-9275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-23
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY309168-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse