Healthcare Provider Details

I. General information

NPI: 1053287185
Provider Name (Legal Business Name): MISS AMANDA BETHANY GRAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2025
Last Update Date: 06/06/2026
Certification Date: 06/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4930 POLK ST APT 86
NORTH HIGHLANDS CA
95660-5219
US

IV. Provider business mailing address

4930 POLK ST APT 86
NORTH HIGHLANDS CA
95660-5219
US

V. Phone/Fax

Practice location:
  • Phone: 916-661-0911
  • Fax:
Mailing address:
  • Phone: 916-661-0911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: