Provider Demographics
NPI:1871198788
Name:MEDA, AMANDA MERCEDES
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:MERCEDES
Last Name:MEDA
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 1:11500 N TAYLOR RD
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-9745
Mailing Address - Country:US
Mailing Address - Phone:510-798-5350
Mailing Address - Fax:
Practice Address - Street 1:6316 N 10TH ST STE G
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-3599
Practice Address - Country:US
Practice Address - Phone:956-972-0404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist