Healthcare Provider Details

I. General information

NPI: 1386784809
Provider Name (Legal Business Name): AMANDA SLIGH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 11/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 VONDERBURG DRIVE SUITE 201
BRANDON FL
33511
US

IV. Provider business mailing address

602 VONDERBURG DR SUITE 201
BRANDON FL
33511-5900
US

V. Phone/Fax

Practice location:
  • Phone: 813-653-1149
  • Fax:
Mailing address:
  • Phone: 813-653-1149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSI1739
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: