Healthcare Provider Details

I. General information

NPI: 1093032492
Provider Name (Legal Business Name): AMANDA MARIE BECCALONI DNP, CRNA, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2010
Last Update Date: 04/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3225 SPARTAN RD
OLNEY MD
20832-2335
US

IV. Provider business mailing address

23 PIERSIDE DR APT. 429
BALTIMORE MD
21230-5463
US

V. Phone/Fax

Practice location:
  • Phone: 570-650-0191
  • Fax:
Mailing address:
  • Phone: 570-650-0191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9264304
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number193062
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: