Healthcare Provider Details

I. General information

NPI: 1396651873
Provider Name (Legal Business Name): AMANDA BRADY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 117
ORANGE SPRINGS FL
32182-0117
US

IV. Provider business mailing address

14249 NE 232ND LANE RD
FORT MC COY FL
32134-3308
US

V. Phone/Fax

Practice location:
  • Phone: 352-293-6610
  • Fax:
Mailing address:
  • Phone: 352-293-6610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13646
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: