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General NPI Number Information
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NPI Number | 1750658126
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Entity Type | Individual
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Provider Name | AMANDA DOVE CONNELLY AU.D.
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Gender | Female
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Dates
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Enumeration Date | 11/29/2011
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Last Update Date | 02/17/2021
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Provider Practice Location Address
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Address Line | 101 CLARKE PL
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City | FREDERICK
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State | MD
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Zip | 21701
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Country | US
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Telephone | 301-360-2087
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Fax | 301-360-1403
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Provider Business Mailing Address
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Address Line | 1333 GREYSWOOD RD
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City | ODENTON
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State | MD
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Zip | 21113-2118
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Country | US
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Telephone | 240-604-5501
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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 | 231H00000X
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Taxonomy Name | Audiologist
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License Number | AUD000075
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 01275
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License Number State | MD
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