Healthcare Provider Details

I. General information

NPI: 1801699723
Provider Name (Legal Business Name): AMANDA RAYMOND MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2025
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

636 DEL PRADO BLVD S
CAPE CORAL FL
33990-2668
US

IV. Provider business mailing address

14321 75TH LN N
LOXAHATCHEE FL
33470-5284
US

V. Phone/Fax

Practice location:
  • Phone: 239-424-3161
  • Fax:
Mailing address:
  • Phone: 561-301-5696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number183924
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: