Provider Demographics
NPI:1578044715
Name:STANIFER, AMANDA (DTCS)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:STANIFER
Suffix:
Gender:F
Credentials:DTCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14267 OLD PINE LN
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-1854
Mailing Address - Country:US
Mailing Address - Phone:574-286-7146
Mailing Address - Fax:
Practice Address - Street 1:14267 OLD PINE LN
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-1854
Practice Address - Country:US
Practice Address - Phone:574-286-7146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-26
Last Update Date:2018-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist