Provider Demographics
NPI:1346426806
Name:PERSAUD, AMANDA
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:PERSAUD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4850 CTY RD 10
Mailing Address - Street 2:
Mailing Address - City:SAMSON
Mailing Address - State:AL
Mailing Address - Zip Code:36477
Mailing Address - Country:US
Mailing Address - Phone:850-537-9395
Mailing Address - Fax:850-537-9398
Practice Address - Street 1:4850 CTY RD 10
Practice Address - Street 2:
Practice Address - City:SAMSON
Practice Address - State:AL
Practice Address - Zip Code:36477
Practice Address - Country:US
Practice Address - Phone:850-537-9395
Practice Address - Fax:850-537-9398
Is Sole Proprietor?:No
Enumeration Date:2008-01-15
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALX96088Medicare UPIN