Healthcare Provider Details

I. General information

NPI: 1962850362
Provider Name (Legal Business Name): AMANDA JOLIE O'NEIL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA JOLIE OURO PA-C

II. Dates (important events)

Enumeration Date: 05/26/2016
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44344 DEQUINDRE RD STE 560
STERLING HEIGHTS MI
48314-1043
US

IV. Provider business mailing address

26901 BEAUMONT BLVD STE 3D
SOUTHFIELD MI
48033-3849
US

V. Phone/Fax

Practice location:
  • Phone: 947-523-4590
  • Fax: 947-523-4535
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601007748
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: