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NPI Code Detail

MEDICARE: MRS. AMANDA GALLUP

MEDICARE:  MRS. AMANDA  GALLUP
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
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1659786549
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. AMANDA GALLUP
Provider Business Mailing Address
First Line : 8043 CORPORATE CIRCLE SUITE #1
Second Line :
City : NORTH ROYALTON
State : OH
Zip : 44133
Country : US
Telephone Number : 440-886-1376
Fax Number :
Provider Business Practice Location Address
First Line : 8043 CORPORATE CIRCLE SUITE #1
Second Line :
City : NORTH ROYALTON
State : OH
Zip : 44133
Country : US
Telephone Number : 440-886-1376
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2014
Last Update Date : 06/30/2014

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Directions to “ MRS. AMANDA GALLUP ” Practice Location

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