Healthcare Provider Details

I. General information

NPI: 1427970912
Provider Name (Legal Business Name): MS. AMANDA S OCONNOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 W OSCEOLA AVE
CLEWISTON FL
33440-3008
US

IV. Provider business mailing address

834 CONCORDIA AVE
CLEWISTON FL
33440-2640
US

V. Phone/Fax

Practice location:
  • Phone: 863-677-0994
  • Fax:
Mailing address:
  • Phone: 863-677-0994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: