Provider Demographics
NPI:1376949198
Name:PRICE, AMANDA (AA)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:PRICE
Suffix:
Gender:F
Credentials:AA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5455 N MARGINAL RD
Mailing Address - Street 2:APT. 412
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44114-3937
Mailing Address - Country:US
Mailing Address - Phone:330-350-6244
Mailing Address - Fax:
Practice Address - Street 1:5455 N MARGINAL RD
Practice Address - Street 2:APT. 412
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44114-3937
Practice Address - Country:US
Practice Address - Phone:330-350-6244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-05
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH67.000239367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant