Provider Demographics
NPI:1205580586
Name:HENDERSON, AMANDA (MBA)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25130 NW 9TH LN
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32669-3537
Mailing Address - Country:US
Mailing Address - Phone:352-219-1661
Mailing Address - Fax:
Practice Address - Street 1:901 NW 8TH AVE STE B5-1
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-5011
Practice Address - Country:US
Practice Address - Phone:352-219-1661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-07
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management