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NPI Code Detail

MEDICARE: AMANDA DEVANE PHD

MEDICARE: AMANDA DEVANE PHD
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
1103T00000XPsychologistPSY33740CA

General Provider Information

NPI Number : 1619689023
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA DEVANE PHD
Provider Business Mailing Address
First Line : 520 CHADBOURNE RD
Second Line :
City : FAIRFIELD
State : CA
Zip : 94534-9656
Country : US
Telephone Number : 707-366-3674
Fax Number :
Provider Business Practice Location Address
First Line : 520 CHADBOURNE RD
Second Line :
City : FAIRFIELD
State : CA
Zip : 94534-9656
Country : US
Telephone Number : 707-366-3674
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/16/2022
Last Update Date : 12/16/2022

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