Healthcare Provider Details

I. General information

NPI: 1487080388
Provider Name (Legal Business Name): AMANDA ZIEGLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2013
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10272 S US HIGHWAY 1
PORT SAINT LUCIE FL
34952-5615
US

IV. Provider business mailing address

3344 NE SANDRA DR
JENSEN BEACH FL
34957-3972
US

V. Phone/Fax

Practice location:
  • Phone: 407-947-4675
  • Fax:
Mailing address:
  • Phone: 407-947-4675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-20-45234
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-19-90942
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: