Healthcare Provider Details

I. General information

NPI: 1205523461
Provider Name (Legal Business Name): AMANDA M START
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2023
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 JACK MARTIN BLVD
BRICK NJ
08724-7732
US

IV. Provider business mailing address

332 MARIA DR
TOMS RIVER NJ
08753-2441
US

V. Phone/Fax

Practice location:
  • Phone: 732-840-2200
  • Fax:
Mailing address:
  • Phone: 732-608-4276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ01471300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: