MEDICARE: AMANDA LEE STAPLETON LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	MA60867	FL

General Provider Information

NPI Number	:	1518303304
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA LEE STAPLETON LMT

Provider Business Mailing Address
First Line	:	115 E GRANADA BLVD STE 1
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32176-6634
Country	:	US
Telephone Number	:	386-677-5400
Fax Number	:	386-677-5420

Provider Business Practice Location Address
First Line	:	115 E GRANADA BLVD STE 1
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32176-6634
Country	:	US
Telephone Number	:	386-677-5400
Fax Number	:	386-677-5420

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2013
Last Update Date	:	05/20/2013

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