Provider Demographics
NPI:1558778092
Name:CHURKOO, AMANDA ALMONTE
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:ALMONTE
Last Name:CHURKOO
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 1:3727 PROVIDENCE RD
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-8537
Mailing Address - Country:US
Mailing Address - Phone:917-686-4702
Mailing Address - Fax:
Practice Address - Street 1:3066 JOG RD
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33467-8537
Practice Address - Country:US
Practice Address - Phone:561-450-5080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-16
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13858224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant