Provider Demographics
NPI:1104364736
Name:SHAWGO, AMANDA F
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:F
Last Name:SHAWGO
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 1:239 BOOMERANG DR
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:PA
Mailing Address - Zip Code:17522-2442
Mailing Address - Country:US
Mailing Address - Phone:717-715-4647
Mailing Address - Fax:
Practice Address - Street 1:918 N READING RD
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-9794
Practice Address - Country:US
Practice Address - Phone:717-335-2338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-02
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG003657171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor