Provider Demographics
NPI:1679960991
Name:SHUTE, AMANDA
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:SHUTE
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:PO BOX 414
Mailing Address - Street 2:
Mailing Address - City:GILMANTON
Mailing Address - State:NH
Mailing Address - Zip Code:03237-0414
Mailing Address - Country:US
Mailing Address - Phone:603-267-6611
Mailing Address - Fax:
Practice Address - Street 1:211 STONE ROAD
Practice Address - Street 2:
Practice Address - City:GILMANTON
Practice Address - State:NH
Practice Address - Zip Code:03237-0414
Practice Address - Country:US
Practice Address - Phone:603-267-6611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-24
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2572172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker