Provider Demographics
NPI:1093032492
Name:BECCALONI, AMANDA MARIE (DNP, CRNA, FNP-BC)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:MARIE
Last Name:BECCALONI
Suffix:
Gender:F
Credentials:DNP, CRNA, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 PIERSIDE DR
Mailing Address - Street 2:APT. 429
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21230-5463
Mailing Address - Country:US
Mailing Address - Phone:570-650-0191
Mailing Address - Fax:
Practice Address - Street 1:3225 SPARTAN RD
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-2335
Practice Address - Country:US
Practice Address - Phone:570-650-0191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-23
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD193062367500000X
FL9264304363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily