Healthcare Provider Details

I. General information

NPI: 1750765756
Provider Name (Legal Business Name): AMANDA J PILLAI PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA J MARK PSYD

II. Dates (important events)

Enumeration Date: 07/20/2015
Last Update Date: 06/08/2022
Certification Date: 06/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1713 6TH AVE S
BIRMINGHAM AL
35294-2235
US

IV. Provider business mailing address

1713 6TH AVE S
BIRMINGHAM AL
35294-0018
US

V. Phone/Fax

Practice location:
  • Phone: 205-934-4107
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY9225
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number2254
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: