Healthcare Provider Details

I. General information

NPI: 1134062987
Provider Name (Legal Business Name): AMANDA JO DUNAWAY IMH 28406
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2026
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18703 N DALE MABRY HWY
LUTZ FL
33548-4979
US

IV. Provider business mailing address

242 WINDING WILLOW DR
PALM HARBOR FL
34683-5831
US

V. Phone/Fax

Practice location:
  • Phone: 813-219-8844
  • Fax:
Mailing address:
  • Phone: 813-219-8844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number28406
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: