Provider Demographics
NPI:1053856138
Name:AMOAH, CRYSTAL
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:AMOAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 E JONATHAN CT
Mailing Address - Street 2:
Mailing Address - City:KENNETT SQ
Mailing Address - State:PA
Mailing Address - Zip Code:19348-1850
Mailing Address - Country:US
Mailing Address - Phone:484-620-5677
Mailing Address - Fax:
Practice Address - Street 1:1423 CAPITOL TRAIL
Practice Address - Street 2:BUILDING 3
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711
Practice Address - Country:US
Practice Address - Phone:302-454-7520
Practice Address - Fax:302-565-6049
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-28
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP017077363LP0808X
DEL8-0000174363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health