Healthcare Provider Details

I. General information

NPI: 1770767683
Provider Name (Legal Business Name): AMANDA JOY EDMOND PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2007
Last Update Date: 08/06/2025
Certification Date: 05/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2946 E BANNER GATEWAY DR
GILBERT AZ
85234
US

IV. Provider business mailing address

2946 E BANNER GATEWAY DR
GILBERT AZ
85234
US

V. Phone/Fax

Practice location:
  • Phone: 480-256-6444
  • Fax: 480-256-3359
Mailing address:
  • Phone: 480-256-6444
  • Fax: 480-256-3359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1088
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number8620
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: