Healthcare Provider Details

I. General information

NPI: 1922763655
Provider Name (Legal Business Name): AMEGO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2021
Last Update Date: 04/14/2022
Certification Date: 04/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1435 AURORA RD
MELBOURNE FL
32935-5315
US

IV. Provider business mailing address

33 PERRY AVE
ATTLEBORO MA
02703-2417
US

V. Phone/Fax

Practice location:
  • Phone: 321-541-1970
  • Fax: 508-222-0503
Mailing address:
  • Phone: 508-455-6405
  • Fax: 508-222-0503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: RITA PAUL
Title or Position: BILLING SUPERVISOR
Credential:
Phone: 508-455-6405