Individual provider · Type 1 NPI
Amanda Marie Formato, PA-C, ATC
Surgical Physician Assistant · Bethpage, NY
NPI number
1356814842
Active
Practice location
4295 Hempstead Tpke
Bethpage, NY 11714-5713
Mailing address
3868 Green Pl
Bethpage, NY 11714-4208
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Surgical Physician Assistant Primary | 363AS0400X | PA56656 (CA) |
| Physician Assistant | 363A00000X | None listed |
Surgical Physician Assistant: Definition to come...
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About NPI 1356814842
Amanda Marie Formato, PA-C, ATC's National Provider Identifier is 1356814842, issued on Jan 7, 2019. The primary taxonomy on file is Surgical Physician Assistant (363AS0400X), and the practice location is in Bethpage, NY. The record was last updated on Mar 27, 2026.