Provider Demographics
NPI:1255754164
Name:SHANDOR, AMANDA MARIA CASON (FNP-BC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARIA CASON
Last Name:SHANDOR
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4310 LONDONDERRY RD STE 109
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17109-5329
Mailing Address - Country:US
Mailing Address - Phone:717-614-4420
Mailing Address - Fax:
Practice Address - Street 1:4310 LONDONDERRY RD STE 109
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-5329
Practice Address - Country:US
Practice Address - Phone:717-988-0611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-28
Last Update Date:2020-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA005638363LF0000X
PASP021530363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily