Healthcare Provider Details

I. General information

NPI: 1043147960
Provider Name (Legal Business Name): AMANDA SOUSA PERES PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6925 ESTANA LN
AUSTIN TX
78739-2112
US

IV. Provider business mailing address

6925 ESTANA LN
AUSTIN TX
78739-2112
US

V. Phone/Fax

Practice location:
  • Phone: 214-733-1858
  • Fax:
Mailing address:
  • Phone: 214-733-1858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA20354
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: