Provider Demographics
NPI:1124387634
Name:KENNEDY, AMANDA FAYE
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:FAYE
Last Name:KENNEDY
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 1:309 ARRUNDALE DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-4409
Mailing Address - Country:US
Mailing Address - Phone:919-388-3366
Mailing Address - Fax:
Practice Address - Street 1:2908 CONCERTO CT
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27539-3615
Practice Address - Country:US
Practice Address - Phone:919-363-7585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-04
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist