Healthcare Provider Details

I. General information

NPI: 1023938693
Provider Name (Legal Business Name): AMANDA SOPHIE ANTONACCI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 HOLLYWOOD BLVD
HOLLYWOOD FL
33021-6897
US

IV. Provider business mailing address

720 SW 5TH ST
BOCA RATON FL
33486-4618
US

V. Phone/Fax

Practice location:
  • Phone: 561-560-7377
  • Fax:
Mailing address:
  • Phone: 561-843-0048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT25730
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: