Healthcare Provider Details

I. General information

NPI: 1225769581
Provider Name (Legal Business Name): AMANDA FRY BA, CD(DONA)
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2022
Last Update Date: 06/17/2022
Certification Date: 06/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2232 BROWN AVE
SCRANTON PA
18509-1374
US

IV. Provider business mailing address

2232 BROWN AVE
SCRANTON PA
18509-1374
US

V. Phone/Fax

Practice location:
  • Phone: 570-972-3032
  • Fax:
Mailing address:
  • Phone: 570-972-3032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number14813
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: