MEDICARE: AMANDA LYNN GANO PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	PA2684	SC
2	363AM0700X	Medical Physician Assistant	MA053995	PA

General Provider Information

NPI Number	:	1083926505
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA LYNN GANO PA-C

Provider Business Mailing Address
First Line	:	33 WATER TUPELO LN
Second Line	:
City	:	BLUFFTON
State	:	SC
Zip	:	29910-7681
Country	:	US
Telephone Number	:	607-483-8550
Fax Number	:

Provider Business Practice Location Address
First Line	:	845 WILLIAM HILTON PKWY
Second Line	:
City	:	HILTON HEAD
State	:	SC
Zip	:	29928-3404
Country	:	US
Telephone Number	:	843-321-2416
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2010
Last Update Date	:	07/21/2022

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