Healthcare Provider Details

I. General information

NPI: 1295382588
Provider Name (Legal Business Name): AMANDA MARY SHERMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2019
Last Update Date: 08/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 S 4TH ST
AURORA IL
60505-5151
US

IV. Provider business mailing address

632 WATSON ST
AURORA IL
60505-5244
US

V. Phone/Fax

Practice location:
  • Phone: 630-844-9755
  • Fax:
Mailing address:
  • Phone: 630-272-9755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: