Amanda Connelly

Key facts

NPI

1104242098

Entity type

Individual (NPI type 1)

Primary specialty

Counselor 101Y00000X

Practice address

13 Thompson Hay Path
Setauket, NY 11733-1317

Phone

(631) 751-0197

NPI assigned

Mar 15, 2014

Sex

Female

Sole proprietor

Yes

Organizations & group practices 1

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.

• Welllife Network Inc Case Management Agency · Elmont, NY · NPI 1508012816
  NPD (past)

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Practice roles

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Mar 15, 2014.

{
    "created_epoch": "1394841600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1394841600000",
    "number": "1104242098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27 CHERYL DR",
            "city": "SHOREHAM",
            "state": "NY",
            "postal_code": "117862356",
            "telephone_number": "631-294-4348"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13 THOMPSON HAY PATH",
            "city": "SETAUKET",
            "state": "NY",
            "postal_code": "117331317",
            "telephone_number": "631-751-0197"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONNELLY",
        "first_name": "AMANDA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-03-15",
        "last_updated": "2014-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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