Provider Demographics
NPI:1043699655
Name:AMASHA, AUGUSTUS
Entity type:Individual
Prefix:MR
First Name:AUGUSTUS
Middle Name:
Last Name:AMASHA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:952 TROY SCHENECTADY RD
Mailing Address - Street 2:SUITE #: 103
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-1612
Mailing Address - Country:US
Mailing Address - Phone:518-250-4664
Mailing Address - Fax:518-250-4665
Practice Address - Street 1:952 TROY SCHENECTADY RD
Practice Address - Street 2:SUITE #: 103
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-1612
Practice Address - Country:US
Practice Address - Phone:518-250-4664
Practice Address - Fax:518-250-4665
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-28
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY38057343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03280926Medicaid