Provider Demographics
NPI:1619283256
Name:NANASY, AMANDA ANN (OD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:ANN
Last Name:NANASY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1732 N UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-3602
Mailing Address - Country:US
Mailing Address - Phone:954-432-7711
Mailing Address - Fax:954-432-8017
Practice Address - Street 1:1732 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-3602
Practice Address - Country:US
Practice Address - Phone:954-432-7711
Practice Address - Fax:954-432-8017
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-20
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4539152WS0006X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision