Healthcare Provider Details

I. General information

NPI: 1780110544
Provider Name (Legal Business Name): AMANDA WEINGARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 05/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15200 S JOG RD STE B8
DELRAY BEACH FL
33446-1246
US

IV. Provider business mailing address

8205 BERGEN PEAK TER
BOYNTON BEACH FL
33473-5033
US

V. Phone/Fax

Practice location:
  • Phone: 305-305-2717
  • Fax:
Mailing address:
  • Phone: 305-305-2717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number15058
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: