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General NPI Number Information
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NPI Number | 1922981216
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Entity Type | Individual
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Provider Name | AMANDA EVANS
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Gender | Female
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Dates
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Enumeration Date | 07/26/2025
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Last Update Date | 07/31/2025
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Provider Practice Location Address
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Address Line | 256 BOSTON POST RD
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City | WATERFORD
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State | CT
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Zip | 06385-2054
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Country | US
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Telephone | 860-222-5513
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Fax |
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Provider Business Mailing Address
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Address Line | 292 S FRONTAGE RD # 1036
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City | NEW LONDON
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State | CT
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Zip | 06320-2641
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Country | US
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Telephone | 860-222-5513
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 70376
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License Number State | CT
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