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General NPI Number Information
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NPI Number | 1821215641
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Entity Type | Individual
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Provider Name | AMANDA ERIN HAYNES D.O.
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Gender | Female
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Dates
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Enumeration Date | 04/20/2007
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Last Update Date | 03/30/2023
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Provider Practice Location Address
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Address Line | 100 N ACADEMY AVE 19-30
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City | DANVILLE
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State | PA
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Zip | 17822-9800
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Country | US
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Telephone | 570-214-1982
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Fax |
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Provider Business Mailing Address
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Address Line | 10790 RANCHO BERNARDO RD
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City | SAN DIEGO
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State | CA
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Zip | 92127-5705
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Country | US
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Telephone | 858-554-8605
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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 | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 20A800
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | OT011209
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | OS014610
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License Number State | PA
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