Healthcare Provider Details

I. General information

NPI: 1568793545
Provider Name (Legal Business Name): AMANDA WANG AP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2010
Last Update Date: 05/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8703 HASTINGS BEACH BLVD
ORLANDO FL
32829-8817
US

IV. Provider business mailing address

8703 HASTINGS BEACH BLVD
ORLANDO FL
32829-8817
US

V. Phone/Fax

Practice location:
  • Phone: 863-944-3986
  • Fax:
Mailing address:
  • Phone: 863-944-3986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: