Healthcare Provider Details

I. General information

NPI: 1063362911
Provider Name (Legal Business Name): AMANDA MENEZES PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3305 US HIGHWAY 98 S
LAKELAND FL
33803-8365
US

IV. Provider business mailing address

1010 CENTRAL AVE APT 121
ST PETERSBURG FL
33705-6651
US

V. Phone/Fax

Practice location:
  • Phone: 863-344-3898
  • Fax:
Mailing address:
  • Phone: 757-409-8197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA1244604
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: