Amanda Marie Wiermann, P.A.

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

006495 Issued in NY

Practice address

PO Box 263
Port Jefferson Station, NY 11776-0263

Phone

(631) 828-5419

Fax

(631) 403-1298

NPI assigned

May 25, 2012

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Custom TRT US Inc

  • Medical Specialty Clinic/Center
  • Port Jefferson Station, NY
  • NPI 1528883725
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1337904000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750636800000",
    "number": "1023378874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 263",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117760263",
            "telephone_number": "631-260-1945",
            "fax_number": "631-403-1298"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "PO BOX 263",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117760263",
            "telephone_number": "631-828-5419",
            "fax_number": "631-403-1298"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIERMANN",
        "first_name": "AMANDA",
        "middle_name": "MARIE",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-05-25",
        "last_updated": "2025-06-23",
        "certification_date": "2025-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": "006495",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "006495",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ayanna Wesley, NP
• Roger W Wetsell, PT
• Danielle Whelan
• Kailey Veronica White
• Laurie A White, LCSW
• Richard John Wieting, M.D.
• Peter Wigg, PSY. D.
• Jeanmarie Williams, RN, LMSW
• Patricia Williams
• Robert Franklin Wilson, MD

• Physician Assistant in Port Jefferson Station, NY
• Providers in Port Jefferson Station, NY by specialty
• Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.