Healthcare Provider Details

I. General information

NPI: 1578928362
Provider Name (Legal Business Name): AMANDA SCOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA EVANS

II. Dates (important events)

Enumeration Date: 12/21/2015
Last Update Date: 12/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 S VOLUSIA AVE
ORANGE CITY FL
32763-7625
US

IV. Provider business mailing address

1566 MARGARET ST
DELAND FL
32720-8453
US

V. Phone/Fax

Practice location:
  • Phone: 386-279-2554
  • Fax:
Mailing address:
  • Phone: 386-279-2554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW13278
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: