Provider Demographics
NPI:1083238166
Name:MCCOMBS, AMANDA TAYLOR
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:TAYLOR
Last Name:MCCOMBS
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 1:1853 HORSESHOE POINT RD
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23432-1823
Mailing Address - Country:US
Mailing Address - Phone:757-377-9841
Mailing Address - Fax:
Practice Address - Street 1:1853 HORSESHOE POINT RD
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23432-1823
Practice Address - Country:US
Practice Address - Phone:757-377-9841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-03
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2000038409Other22