MEDICARE: MRS. AMANDA JOYCE PONTE 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	363A00000X	Physician Assistant	3546	CT

General Provider Information

NPI Number	:	1356702831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMANDA JOYCE PONTE PA-C

Provider Business Mailing Address
First Line	:	1155 35TH LN STE 201A
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32960-6537
Country	:	US
Telephone Number	:	772-562-5661
Fax Number	:

Provider Business Practice Location Address
First Line	:	1155 35TH LN STE 201A
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32960-6537
Country	:	US
Telephone Number	:	772-562-5661
Fax Number	:	772-562-5702

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

Provider Enumeration Date	:	03/11/2016
Last Update Date	:	01/25/2024

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