MEDICARE: AMANDA GRACE DANCY PA-C

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	363A00000X	Physician Assistant	104075	NC
2	363AS0400X	Surgical Physician Assistant	104075	NC

General Provider Information

NPI Number	:	1568467272
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA GRACE DANCY PA-C

Provider Business Mailing Address
First Line	:	509 N ELAM AVE FL 2
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27403-1157
Country	:	US
Telephone Number	:	336-274-1114
Fax Number	:	336-274-9638

Provider Business Practice Location Address
First Line	:	509 N ELAM AVE FL 2
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27403
Country	:	US
Telephone Number	:	336-274-1114
Fax Number	:	336-274-9638

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

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	06/27/2018

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Directions to “ AMANDA GRACE DANCY PA-C” Practice Location

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