Healthcare Provider Details

I. General information

NPI: 1982430724
Provider Name (Legal Business Name): AMANDA SITOLOMA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2024
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 BANNING ST STE 280
DOVER DE
19904-3489
US

IV. Provider business mailing address

PO BOX 67537
NEWARK NJ
07101-8009
US

V. Phone/Fax

Practice location:
  • Phone: 302-400-9999
  • Fax: 302-487-1167
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberLG-0012879
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: