Provider Demographics
NPI:1437339405
Name:MAFINEJAD, AMANDA ANN COOK
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:ANN COOK
Last Name:MAFINEJAD
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 1:508 SADDLESTONE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-8204
Mailing Address - Country:US
Mailing Address - Phone:407-221-6274
Mailing Address - Fax:
Practice Address - Street 1:508 SADDLESTONE DR
Practice Address - Street 2:
Practice Address - City:SAINT JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259-8204
Practice Address - Country:US
Practice Address - Phone:407-221-6274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-07
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05627225X00000X
FL17208225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist