Healthcare Provider Details

I. General information

NPI: 1821369190
Provider Name (Legal Business Name): AUDREY LYNN AMADEO MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2012
Last Update Date: 11/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3520 OAKS WAY APT 904
POMPANO BEACH FL
33069
US

IV. Provider business mailing address

19321 W SAINT ANDREWS DR
HIALEAH FL
33015-2337
US

V. Phone/Fax

Practice location:
  • Phone: 305-807-1909
  • Fax:
Mailing address:
  • Phone: 305-215-1773
  • Fax: 954-577-7780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-19-37799
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: