Provider Demographics
NPI:1639716467
Name:AMODEO, ALEXANDRIA (MA)
Entity Type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:
Last Name:AMODEO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5017 BIG BEND DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:SC
Mailing Address - Zip Code:29720-0147
Mailing Address - Country:US
Mailing Address - Phone:704-280-1009
Mailing Address - Fax:
Practice Address - Street 1:6817 SOUTHPOINT PKWY STE 1602
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-6298
Practice Address - Country:US
Practice Address - Phone:904-945-7556
Practice Address - Fax:904-379-0113
Is Sole Proprietor?:No
Enumeration Date:2019-11-27
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist