Provider Demographics
NPI:1679993539
Name:CHRISTIE, AMANDA (PA-C)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:CHRISTIE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 EAST AVE STE 3A
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-5726
Mailing Address - Country:US
Mailing Address - Phone:203-899-0744
Mailing Address - Fax:203-899-0761
Practice Address - Street 1:148 EAST AVE STE 3A
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-5726
Practice Address - Country:US
Practice Address - Phone:203-899-0744
Practice Address - Fax:203-899-0761
Is Sole Proprietor?:No
Enumeration Date:2014-04-18
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3065363AM0700X
CT003065363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant