Healthcare Provider Details

I. General information

NPI: 1952177990
Provider Name (Legal Business Name): AMANDA B MERRITT CSFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2023
Last Update Date: 11/30/2023
Certification Date: 11/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 WAYNE MEMORIAL DR
GOLDSBORO NC
27534-9494
US

IV. Provider business mailing address

2700 WAYNE MEMORIAL DR
GOLDSBORO NC
27534-9494
US

V. Phone/Fax

Practice location:
  • Phone: 919-731-6065
  • Fax: 919-587-2968
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: