Healthcare Provider Details

I. General information

NPI: 1710818372
Provider Name (Legal Business Name): AMANDA LEE STEPHENS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2026
Last Update Date: 05/25/2026
Certification Date: 05/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 PENNEY AVE
NEWARK OH
43055-6644
US

IV. Provider business mailing address

46 PENNEY AVE
NEWARK OH
43055-6644
US

V. Phone/Fax

Practice location:
  • Phone: 740-755-0065
  • Fax: 740-755-0065
Mailing address:
  • Phone: 740-755-0065
  • Fax: 740-755-0065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: