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NPI Code Detail

MEDICARE: DR. AMANDA J GACCETTA DO

MEDICARE: DR. AMANDA J GACCETTA DO
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
1207V00000XObstetrics & Gynecology Physician62580-21WI
2390200000XStudent in an Organized Health Care Education/Training Program
3207V00000XObstetrics & Gynecology PhysicianR2854TX

General Provider Information

NPI Number : 1417219197
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. AMANDA J GACCETTA DO
Provider Business Mailing Address
First Line : 2300 LONE STAR RD
Second Line :
City : MANSFIELD
State : TX
Zip : 76063-8744
Country : US
Telephone Number : 682-341-5000
Fax Number :
Provider Business Practice Location Address
First Line : 2300 LONE STAR RD
Second Line :
City : MANSFIELD
State : TX
Zip : 76063-8744
Country : US
Telephone Number : 682-341-5000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/08/2012
Last Update Date : 08/05/2025

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