MEDICARE: AMANDA E FRUSCO

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	106S00000X	Behavior Technician	RBT-25-42082	FL
2	101YP2500X	Professional Counselor		NJ

General Provider Information

NPI Number	:	1255871695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA E FRUSCO

Provider Business Mailing Address
First Line	:	2651 W PRICE BLVD
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34286-4928
Country	:	US
Telephone Number	:	908-581-2061
Fax Number	:

Provider Business Practice Location Address
First Line	:	4418 5TH ST W
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34207-1531
Country	:	US
Telephone Number	:	727-492-5369
Fax Number	:

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

Provider Enumeration Date	:	03/05/2017
Last Update Date	:	11/07/2025

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Directions to “ AMANDA E FRUSCO ” Practice Location

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