MEDICARE: AMANDA SABRIA NICKELBERRY

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	225700000X	Massage Therapist	MT-2026-0022	NM

General Provider Information

NPI Number	:	1962353607
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA SABRIA NICKELBERRY

Provider Business Mailing Address
First Line	:	2724 W DIVISION ST APT 3F
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-2825
Country	:	US
Telephone Number	:	773-531-3285
Fax Number	:

Provider Business Practice Location Address
First Line	:	4611 GREENE ST NW STE 304
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87114-4284
Country	:	US
Telephone Number	:	505-890-8678
Fax Number	:

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

Provider Enumeration Date	:	02/09/2026
Last Update Date	:	02/09/2026

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