Healthcare Provider Details

I. General information

NPI: 1790311975
Provider Name (Legal Business Name): AMANDA CYR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2020
Last Update Date: 03/19/2020
Certification Date: 03/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 BLYTHE BLVD
CHARLOTTE NC
28203-5812
US

IV. Provider business mailing address

3046 JAMESTOWN DR
GASTONIA NC
28054-6056
US

V. Phone/Fax

Practice location:
  • Phone: 704-381-8100
  • Fax:
Mailing address:
  • Phone: 704-315-9574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number227836
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: