Provider Demographics
NPI:1609461474
Name:DRISCOLL, AMANDA CHRISTINE (PA)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:CHRISTINE
Last Name:DRISCOLL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3810 BUTLER ST
Mailing Address - Street 2:UNIT 2
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15201-1822
Mailing Address - Country:US
Mailing Address - Phone:724-766-6648
Mailing Address - Fax:
Practice Address - Street 1:4401 PENN AVE FL 2
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224-1334
Practice Address - Country:US
Practice Address - Phone:412-692-5090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-04
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA062188363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical