Provider Demographics
NPI:1689038143
Name:RESTO, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:RESTO
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 1:4812 TAMPA DOWNS BLVD
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33559-6207
Mailing Address - Country:US
Mailing Address - Phone:813-406-2520
Mailing Address - Fax:
Practice Address - Street 1:16414 LAKE CHURCH DR
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:FL
Practice Address - Zip Code:33556-2637
Practice Address - Country:US
Practice Address - Phone:813-382-2722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-11
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician