Healthcare Provider Details

I. General information

NPI: 1023922978
Provider Name (Legal Business Name): AMY MAMMARELLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 N WALNUT ST
BIRDSBORO PA
19508-2005
US

IV. Provider business mailing address

135 N WALNUT ST
BIRDSBORO PA
19508-2005
US

V. Phone/Fax

Practice location:
  • Phone: 610-507-6136
  • Fax:
Mailing address:
  • Phone: 610-507-6136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number176660
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: