Healthcare Provider Details

I. General information

NPI: 1912861634
Provider Name (Legal Business Name): AMANDA MARIE MCCAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13051 EVENING CREEK DR S UNIT 48
SAN DIEGO CA
92128-8120
US

IV. Provider business mailing address

1263 HOLLYHOCK ST
LIVERMORE CA
94551-1405
US

V. Phone/Fax

Practice location:
  • Phone: 501-772-2875
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number7075
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: