Provider Demographics
NPI:1972054013
Name:DAVIS, AMANDA LEE
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:LEE
Last Name:DAVIS
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 1:1761 LISBON ST
Mailing Address - Street 2:UNIT 2
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-3525
Mailing Address - Country:US
Mailing Address - Phone:207-777-1134
Mailing Address - Fax:207-777-1864
Practice Address - Street 1:1761 LISBON ST
Practice Address - Street 2:UNIT 2
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-3525
Practice Address - Country:US
Practice Address - Phone:207-777-1134
Practice Address - Fax:207-777-1864
Is Sole Proprietor?:No
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDL417237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist