Healthcare Provider Details

I. General information

NPI: 1467761908
Provider Name (Legal Business Name): AMANDA MARIE COLELLA MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2010
Last Update Date: 10/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 LEE RD
WINTER PARK FL
32789-1750
US

IV. Provider business mailing address

624 KENWICK CIR APT 203
CASSELBERRY FL
32707-7004
US

V. Phone/Fax

Practice location:
  • Phone: 407-339-7451
  • Fax:
Mailing address:
  • Phone: 561-310-3063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: