Provider Demographics
NPI:1245243740
Name:MAHANANDA, AMAREE (LMT)
Entity Type:Individual
Prefix:MISS
First Name:AMAREE
Middle Name:
Last Name:MAHANANDA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 NW 6TH ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32609-3531
Mailing Address - Country:US
Mailing Address - Phone:352-378-4848
Mailing Address - Fax:352-378-5166
Practice Address - Street 1:1705 NW 6TH ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32609-3531
Practice Address - Country:US
Practice Address - Phone:352-378-4848
Practice Address - Fax:352-378-5166
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA0012198225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC5536OtherBCBS PROVIDER NUMBER