Healthcare Provider Details

I. General information

NPI: 1639716467
Provider Name (Legal Business Name): ALEXANDRIA AMODEO M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2019
Last Update Date: 04/04/2022
Certification Date: 04/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6817 SOUTHPOINT PKWY STE 1602
JACKSONVILLE FL
32216-6298
US

IV. Provider business mailing address

5017 BIG BEND DR
LANCASTER SC
29720-0147
US

V. Phone/Fax

Practice location:
  • Phone: 904-945-7556
  • Fax: 904-379-0113
Mailing address:
  • Phone: 704-280-1009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: