Provider Demographics
NPI:1205068293
Name:SWEENEY, AMANDA ANN (LAC)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:ANN
Last Name:SWEENEY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1437 CONEFLOWER LN
Mailing Address - Street 2:
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-5802
Mailing Address - Country:US
Mailing Address - Phone:913-375-6590
Mailing Address - Fax:
Practice Address - Street 1:1437 CONEFLOWER LN
Practice Address - Street 2:
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-5802
Practice Address - Country:US
Practice Address - Phone:913-375-6590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-10
Last Update Date:2009-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1476171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist