Provider Demographics
NPI:1508147687
Name:NEAL, AMANDA ROSE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:ROSE
Last Name:NEAL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 N 18TH ST STE 302
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-3734
Mailing Address - Country:US
Mailing Address - Phone:602-254-0200
Mailing Address - Fax:602-254-0237
Practice Address - Street 1:525 N 18TH ST STE 302
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-3734
Practice Address - Country:US
Practice Address - Phone:602-254-0200
Practice Address - Fax:602-254-0237
Is Sole Proprietor?:No
Enumeration Date:2011-09-02
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4931363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant