Provider Demographics
NPI:1255687836
Name:BUCCI, AMANDA (LAC)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:
Last Name:BUCCI
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 FORSYTHE AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43201-3234
Mailing Address - Country:US
Mailing Address - Phone:614-329-8442
Mailing Address - Fax:
Practice Address - Street 1:4140 TULLER RD
Practice Address - Street 2:#104
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-5013
Practice Address - Country:US
Practice Address - Phone:614-329-8442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-01
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH65.000189171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist