Individual provider Active NPI

Amanda Leigh Nicholas, FNP-C

  • Family Nurse Practitioner
  • Syracuse, NY
National Provider Identifier
1689452013
Registry record updated Mar 12, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
351986 Issued in NY
Practice address
1050 W Genesee St
Syracuse, NY 13204-2243
Phone
(315) 641-2385
Fax
(315) 305-4677
NPI assigned
Sep 18, 2023
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 12, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 351986 NY Primary

Addresses

Primary practice location

1050 W Genesee St
Syracuse, NY 13204-2243

Mailing address

1050 W Genesee St
Syracuse, NY 13204-2243
Phone (315) 477-4663

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20240318001166 NY Practitioner - Nurse Practitioner 8921445644 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Nascentia Community CareGroup PAC ID 9830098318, 3 clinicians
St Josephs Medical PCGroup PAC ID 4688855844, 388 clinicians

Practice addresses (Care Compare)

1050 W Genesee St
Syracuse, NY 13204-2243
Phone (315) 641-2385

5100 W Taft Rd
Liverpool, NY 13088-3807
Phone (315) 452-2828

5100 W Taft Rd
Liverpool, NY 13088-4841

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
North Medical PC Current Accepting new patients
Nascentia Community Care CurrentSince Mar 9, 2026 Accepting new patients
St Josephs Medical PC CurrentSince Jan 22, 2024 Accepting new patients

Locations

5100 W Taft Rd
Ste 2T
Liverpool, NY 13088
Phone (315) 744-1592

1050 W Genesee St
Syracuse, NY 13204
Phone (315) 424-3744

301 Prospect Ave
Syracuse, NY 13203
Phone (315) 448-5111

301 Prospect Ave
Ofc
Syracuse, NY 13203
Phone (315) 448-2876

Interoperability endpoints

  • Direct secure messaging: anicholas3126379@direct.trinity-health.org

Organizations & group practices 3

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1694995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1773273600000",
    "number": "1689452013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1050 W GENESEE ST",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132042243",
            "telephone_number": "315-477-4663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1050 W GENESEE ST",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132042243",
            "telephone_number": "315-641-2385",
            "fax_number": "315-305-4677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLAS",
        "first_name": "AMANDA",
        "middle_name": "LEIGH",
        "credential": "FNP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-09-18",
        "last_updated": "2026-03-12",
        "certification_date": "2026-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "351986",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Syracuse, NY

Sources for this page

Verify at the official NPI Registry.