Healthcare Provider Details

I. General information

NPI: 1891325163
Provider Name (Legal Business Name): AMANDA D DOHME
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2020
Last Update Date: 01/24/2020
Certification Date: 01/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 WESTHALL LN STE 207
MAITLAND FL
32751-7478
US

IV. Provider business mailing address

5465 FRIARSWAY DR
TAMPA FL
33624-4164
US

V. Phone/Fax

Practice location:
  • Phone: 800-840-2528
  • Fax:
Mailing address:
  • Phone: 904-463-2603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW10502
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: