MEDICARE: MS. AMANDA L PAY AUD

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	231H00000X	Audiologist	6279810-4101	UT

General Provider Information

NPI Number	:	1801080270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AMANDA L PAY AUD

Provider Business Mailing Address
First Line	:	1382 W BLACK WULFF CIR
Second Line	:
City	:	BLUFFDALE
State	:	UT
Zip	:	84065-5675
Country	:	US
Telephone Number	:	801-450-9266
Fax Number	:

Provider Business Practice Location Address
First Line	:	3741 W 12600 S
Second Line	:
City	:	RIVERTON
State	:	UT
Zip	:	84065-7215
Country	:	US
Telephone Number	:	801-662-4957
Fax Number	:

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

Provider Enumeration Date	:	08/29/2007
Last Update Date	:	07/09/2019

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