Healthcare Provider Details

I. General information

NPI: 1508346339
Provider Name (Legal Business Name): AMANDA KAYE CIFUENTES M.S. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2018
Last Update Date: 02/20/2023
Certification Date: 02/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

494 W CENTRAL AVE
DELAWARE OH
43015-1470
US

IV. Provider business mailing address

3015 COOPER BLUFF DR
COLUMBUS OH
43231-2959
US

V. Phone/Fax

Practice location:
  • Phone: 740-369-3650
  • Fax:
Mailing address:
  • Phone: 513-435-1439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: