Healthcare Provider Details

I. General information

NPI: 1467736306
Provider Name (Legal Business Name): AMANDA MARIE THORNTON AU. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2011
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 DEWITT LOOP, SUNRISE PAVILION, SECOND FLOOR FORT BELVOIR COMMUNITY HOSPITAL
FORT BELVIOR VA
22060-1298
US

IV. Provider business mailing address

9300 DEWITT LOOP
FORT BELVOIR VA
22060-5285
US

V. Phone/Fax

Practice location:
  • Phone: 571-231-2725
  • Fax:
Mailing address:
  • Phone: 571-231-2548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number8013696-4101
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: