Healthcare Provider Details

I. General information

NPI: 1114206794
Provider Name (Legal Business Name): AMANDA LEE SCOTT AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA LAUREN LEE AU.D.

II. Dates (important events)

Enumeration Date: 08/12/2011
Last Update Date: 01/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 N DUNLAP ST
MEMPHIS TN
38105-4625
US

IV. Provider business mailing address

51 N DUNLAP ST
MEMPHIS TN
38105-4625
US

V. Phone/Fax

Practice location:
  • Phone: 901-287-6645
  • Fax:
Mailing address:
  • Phone: 901-287-6645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAU2779
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberHA7603
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number1664
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: