MEDICARE: DR. AMANDA LEE DELLA PENNA DVM

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	174400000X	Specialist	BV012274	PA

General Provider Information

NPI Number	:	1710406087
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMANDA LEE DELLA PENNA DVM

Provider Business Mailing Address
First Line	:	2810 WASHINGTON RD
Second Line	:
City	:	MCMURRAY
State	:	PA
Zip	:	15317
Country	:	US
Telephone Number	:	724-717-2273
Fax Number	:	724-638-8318

Provider Business Practice Location Address
First Line	:	2810 WASHINGTON RD
Second Line	:
City	:	MCMURRAY
State	:	PA
Zip	:	15317
Country	:	US
Telephone Number	:	724-717-2273
Fax Number	:	724-638-8318

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

Provider Enumeration Date	:	09/18/2017
Last Update Date	:	09/18/2017

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