Healthcare Provider Details

I. General information

NPI: 1871860825
Provider Name (Legal Business Name): AMANDA JEFFRIES HAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2011
Last Update Date: 11/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1462 3RD ST S
JACKSONVILLE BEACH FL
32250-6310
US

IV. Provider business mailing address

8800 SE SUNNYSIDE RD STE. 300-N
CLACKAMAS OR
97015-5738
US

V. Phone/Fax

Practice location:
  • Phone: 904-246-1660
  • Fax:
Mailing address:
  • Phone: 503-659-5115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberAS3443
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: