Provider Demographics
NPI:1225769581
Name:FRY, AMANDA (BA, CD(DONA))
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:FRY
Suffix:
Gender:F
Credentials:BA, CD(DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2232 BROWN AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18509-1374
Mailing Address - Country:US
Mailing Address - Phone:570-972-3032
Mailing Address - Fax:
Practice Address - Street 1:2232 BROWN AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18509-1374
Practice Address - Country:US
Practice Address - Phone:570-972-3032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-17
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA14813374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula