Provider Demographics
NPI:1710596952
Name:AMSZYNSKI, ANDREA SABINA
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:SABINA
Last Name:AMSZYNSKI
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 1:1780 OAK RD STE C
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-2206
Mailing Address - Country:US
Mailing Address - Phone:678-956-0963
Mailing Address - Fax:
Practice Address - Street 1:1780 OAK RD STE C
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-2206
Practice Address - Country:US
Practice Address - Phone:678-956-0963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-23
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP010699235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GASLP010699OtherGEORGIA STATE LICENSE SPEECH PATHOLOGY