Provider Demographics
NPI:1205355427
Name:PELLERITO, AMANDA Y (PA)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:Y
Last Name:PELLERITO
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:708 STEWART CIR NW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-2170
Mailing Address - Country:US
Mailing Address - Phone:770-378-2209
Mailing Address - Fax:
Practice Address - Street 1:61 WHITCHER ST NE STE 3110
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1179
Practice Address - Country:US
Practice Address - Phone:770-422-2326
Practice Address - Fax:770-422-7797
Is Sole Proprietor?:No
Enumeration Date:2017-09-19
Last Update Date:2019-11-06
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant