Healthcare Provider Details

I. General information

NPI: 1497158919
Provider Name (Legal Business Name): AMANDA SIMPSON M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2014
Last Update Date: 09/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1527 NE 4TH AVE
FT LAUDERDALE FL
33304-1035
US

IV. Provider business mailing address

1527 NE 4TH AVE
FT LAUDERDALE FL
33304-1035
US

V. Phone/Fax

Practice location:
  • Phone: 954-835-5741
  • Fax:
Mailing address:
  • Phone: 954-835-5741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: