Provider Demographics
NPI:1871915579
Name:SHORT-KUCHYNSKAS, AMY LYNNE (MSED)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:LYNNE
Last Name:SHORT-KUCHYNSKAS
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:MRS
Other - First Name:AMY
Other - Middle Name:LYNNE
Other - Last Name:KUCHYNSKAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSED
Mailing Address - Street 1:7 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-2629
Mailing Address - Country:US
Mailing Address - Phone:516-557-5384
Mailing Address - Fax:
Practice Address - Street 1:7 MADISON AVE
Practice Address - Street 2:
Practice Address - City:NORTH BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-2629
Practice Address - Country:US
Practice Address - Phone:516-557-5384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-14
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY851808172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker