Healthcare Provider Details

I. General information

NPI: 1174048649
Provider Name (Legal Business Name): AMANDA SCHADE LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1860 SEMORAN BLVD SUITE 1000
WINTER PARK FL
32792
US

IV. Provider business mailing address

1860 STATE ROAD 436 STE 1000
WINTER PARK FL
32792-2255
US

V. Phone/Fax

Practice location:
  • Phone: 407-657-5029
  • Fax:
Mailing address:
  • Phone: 407-657-5029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number72972
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: