MEDICARE: MRS. AMANDA CHRISTINE MANSELL

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	2355S0801X	Speech-Language Assistant	SI8564	FL
2	222Q00000X	Developmental Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124708300
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMANDA CHRISTINE MANSELL

Provider Business Mailing Address
First Line	:	8961 DANIELS CENTER DR STE 401
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33912-0314
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	604 SW 21ST LN
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33991-7736
Country	:	US
Telephone Number	:	239-980-6155
Fax Number	:

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

Provider Enumeration Date	:	07/21/2023
Last Update Date	:	02/12/2026

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