Provider Demographics
NPI:1457653784
Name:SANDS, AMANDA MARIAN
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARIAN
Last Name:SANDS
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 1:1100 CESERY BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32211-5656
Mailing Address - Country:US
Mailing Address - Phone:904-745-3070
Mailing Address - Fax:904-745-3087
Practice Address - Street 1:1100 CESERY BLVD STE 100
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32211-5656
Practice Address - Country:US
Practice Address - Phone:904-745-3070
Practice Address - Fax:904-745-3087
Is Sole Proprietor?:No
Enumeration Date:2010-11-18
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health