Provider Demographics
NPI:1023260759
Name:STANGO, AMY
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:STANGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:MCGINNIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3430 CULLEN LAKE SHORE DR
Mailing Address - Street 2:
Mailing Address - City:BELLE ISLE
Mailing Address - State:FL
Mailing Address - Zip Code:32812
Mailing Address - Country:US
Mailing Address - Phone:215-431-3374
Mailing Address - Fax:407-704-3088
Practice Address - Street 1:3430 CULLEN LAKE SHORE DR
Practice Address - Street 2:
Practice Address - City:BELLE ISLE
Practice Address - State:FL
Practice Address - Zip Code:32812
Practice Address - Country:US
Practice Address - Phone:215-431-3374
Practice Address - Fax:407-704-3088
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-13
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT12495225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist