Healthcare Provider Details

I. General information

NPI: 1962867341
Provider Name (Legal Business Name): AMANDA BENDER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA BUSSELLS PA

II. Dates (important events)

Enumeration Date: 12/29/2015
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 SAINT CHARLES WAY
YORK PA
17402-4659
US

IV. Provider business mailing address

205 SAINT CHARLES WAY
YORK PA
17402-4659
US

V. Phone/Fax

Practice location:
  • Phone: 717-741-4666
  • Fax: 717-741-9649
Mailing address:
  • Phone: 717-741-4666
  • Fax: 717-741-9649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0006552
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: