Healthcare Provider Details

I. General information

NPI: 1831424456
Provider Name (Legal Business Name): AMANDA W SCHIEBEL PA-C, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2009
Last Update Date: 04/17/2023
Certification Date: 04/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13670 WALSINGHAM RD
LARGO FL
33774-3532
US

IV. Provider business mailing address

13670 WALSINGHAM RD
LARGO FL
33774-3532
US

V. Phone/Fax

Practice location:
  • Phone: 727-593-9848
  • Fax: 727-596-4532
Mailing address:
  • Phone: 727-593-9848
  • Fax: 727-596-4532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA905172
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: