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General NPI Number Information
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NPI Number | 1003728221
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Entity Type | Individual
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Provider Name | AMANDA ROAN
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Gender | Female
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Dates
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Enumeration Date | 09/22/2026
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Last Update Date | 09/22/2026
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Provider Practice Location Address
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Address Line | 21052 SHERIDAN ST STE JM46074
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City | FT LAUDERDALE
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State | FL
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Zip | 33332-2310
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Country | US
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Telephone | 470-738-1581
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Fax |
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Provider Business Mailing Address
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Address Line | 2854 NW 169TH TER
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City | MIAMI GARDENS
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State | FL
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Zip | 33056-4437
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Country | US
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Telephone | 305-331-7369
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | ISW21705
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License Number State | FL
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