Provider Demographics
NPI:1821284365
Name:AQUADRO, AMY CAROLINE (PA-C)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:CAROLINE
Last Name:AQUADRO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:121 N 20TH ST
Mailing Address - Street 2:BLDG 7
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36801-5449
Mailing Address - Country:US
Mailing Address - Phone:334-528-0078
Mailing Address - Fax:
Practice Address - Street 1:121 N 20TH ST
Practice Address - Street 2:BLDG 7
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-5449
Practice Address - Country:US
Practice Address - Phone:334-528-0078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-19
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KST-01551363A00000X
ALPA856363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant