MEDICARE: AMANDA COSTA SAKRAIDA M.ED., SLP

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	235Z00000X	Speech-Language Pathologist		GA

General Provider Information

NPI Number	:	1104764257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA COSTA SAKRAIDA M.ED., SLP

Provider Business Mailing Address
First Line	:	2633 SAINT CHARLES LN NW
Second Line	:
City	:	KENNESAW
State	:	GA
Zip	:	30144-6106
Country	:	US
Telephone Number	:	404-781-4012
Fax Number	:

Provider Business Practice Location Address
First Line	:	707 WHITLOCK AVE SW STE D32
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30064-3083
Country	:	US
Telephone Number	:	770-927-7424
Fax Number	:

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

Provider Enumeration Date	:	03/23/2026
Last Update Date	:	03/23/2026

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