Provider Demographics
NPI:1154665545
Name:PARADISO, AMANDA LINN (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:LINN
Last Name:PARADISO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 FAWN MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:NAUGATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06770-3577
Mailing Address - Country:US
Mailing Address - Phone:724-816-9162
Mailing Address - Fax:
Practice Address - Street 1:200 S ORANGE CENTER RD
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CT
Practice Address - Zip Code:06477-3349
Practice Address - Country:US
Practice Address - Phone:203-772-1444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-26
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2855363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant