MEDICARE: AMANDA SHEFFIELD

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	103K00000X	Behavior Analyst	1-15-18243	CA

General Provider Information

NPI Number	:	1477932663
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA SHEFFIELD

Provider Business Mailing Address
First Line	:	41225 HACIENDA DR
Second Line	:
City	:	MURRIETA
State	:	CA
Zip	:	92562-8728
Country	:	US
Telephone Number	:	951-973-8318
Fax Number	:

Provider Business Practice Location Address
First Line	:	3336 TALBOT ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92106-2944
Country	:	US
Telephone Number	:	619-606-8344
Fax Number	:

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

Provider Enumeration Date	:	05/21/2015
Last Update Date	:	05/21/2015

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