Healthcare Provider Details

I. General information

NPI: 1952743635
Provider Name (Legal Business Name): AMANDA MARIE DONALDSON M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2013
Last Update Date: 06/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 CANTERBURY GRN
STAMFORD CT
06901-2021
US

IV. Provider business mailing address

3 CANTERBURY GRN
STAMFORD CT
06901-2021
US

V. Phone/Fax

Practice location:
  • Phone: 914-224-3444
  • Fax:
Mailing address:
  • Phone: 914-224-3444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number023840
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number4881
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: