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NPI Code Detail

MEDICARE: AMANDA FIDLER

MEDICARE: AMANDA FIDLER
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
1106S00000XBehavior Technician
2103K00000XBehavior Analyst

General Provider Information

NPI Number : 1972028983
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA FIDLER
Provider Business Mailing Address
First Line : 175 MIDDLE ST UNIT 1201
Second Line :
City : LAKE MARY
State : FL
Zip : 32746-3625
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6363 S PECOS RD STE 206
Second Line :
City : LAS VEGAS
State : NV
Zip : 89120-6293
Country : US
Telephone Number : 321-426-7759
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/10/2017
Last Update Date : 11/05/2020

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Directions to “ AMANDA FIDLER ” Practice Location

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