Healthcare Provider Details

I. General information

NPI: 1780184259
Provider Name (Legal Business Name): AMANDA CHRISTINE NEILL IBCLC, LMHC, CST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMANDA CHRISTINE METCALF METCALF

II. Dates (important events)

Enumeration Date: 02/20/2018
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3595 W LAKE MARY BLVD STE B
LAKE MARY FL
32746-6750
US

IV. Provider business mailing address

3595 W LAKE MARY BLVD STE B
LAKE MARY FL
32746-6750
US

V. Phone/Fax

Practice location:
  • Phone: 407-603-5636
  • Fax:
Mailing address:
  • Phone: 407-603-5636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number17828
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number257208
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: