Healthcare Provider Details

I. General information

NPI: 1902475627
Provider Name (Legal Business Name): AMANDA CHURCHILL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2021
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 BOWMAN DR STE E366
VOORHEES NJ
08043-9639
US

IV. Provider business mailing address

301 LIPPINCOTT DR STE 410
MARLTON NJ
08053-4197
US

V. Phone/Fax

Practice location:
  • Phone: 856-247-7295
  • Fax:
Mailing address:
  • Phone: 856-247-7295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00852900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: