MEDICARE: AMANDA CHRISTINE NEILL IBCLC, LMHC, CST

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	174N00000X	Lactation Consultant (Non-RN)	257208
2	101YM0800X	Mental Health Counselor	17828	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MH18585	OTHER	FL	LICENSED MENTAL HEALTH COUNSELOR
2	L-302660	OTHER		INTERNATIONAL BOARD CERTIFIED LACTATION CONSULTANT
3	257208	OTHER		ACADEMY OF LACTATION POLICY AND PRACTICE

General Provider Information

NPI Number	:	1780184259
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA CHRISTINE NEILL IBCLC, LMHC, CST

Provider Business Mailing Address
First Line	:	3595 W LAKE MARY BLVD STE B
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32746-6750
Country	:	US
Telephone Number	:	407-603-5636
Fax Number	:

Provider Business Practice Location Address
First Line	:	3595 W LAKE MARY BLVD STE B
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32746-6750
Country	:	US
Telephone Number	:	407-603-5636
Fax Number	:

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

Provider Enumeration Date	:	02/20/2018
Last Update Date	:	06/09/2026

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