Provider Demographics
NPI:1316390487
Name:DAVIS, AMANDA JOELLE (PHD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:JOELLE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:AMANDA
Other - Middle Name:JOELLE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:16106 73RD TER N
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33418-7474
Mailing Address - Country:US
Mailing Address - Phone:561-203-1964
Mailing Address - Fax:
Practice Address - Street 1:11380 PROSPERITY FARMS RD STE 210B
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410
Practice Address - Country:US
Practice Address - Phone:561-203-1964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-13
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY9491103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical