Provider Demographics
NPI:1023680402
Name:CAVALLO, AMY NOELL (RN, IBCLC)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:NOELL
Last Name:CAVALLO
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 NASNER LN
Mailing Address - Street 2:
Mailing Address - City:SELKIRK
Mailing Address - State:NY
Mailing Address - Zip Code:12158-1236
Mailing Address - Country:US
Mailing Address - Phone:949-280-9002
Mailing Address - Fax:
Practice Address - Street 1:241 NASNER LN
Practice Address - Street 2:
Practice Address - City:SELKIRK
Practice Address - State:NY
Practice Address - Zip Code:12158-1236
Practice Address - Country:US
Practice Address - Phone:949-280-9002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY64377601163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant