Provider Demographics
NPI:1295339398
Name:ADIYIA, AMANDA (APN)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:
Last Name:ADIYIA
Suffix:
Gender:
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 W PROSPECT STREET SUITE 3
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-2736
Mailing Address - Country:US
Mailing Address - Phone:732-301-4465
Mailing Address - Fax:
Practice Address - Street 1:15 W PROSPECT STREET SUITE 3
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-2736
Practice Address - Country:US
Practice Address - Phone:732-301-4465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01074000363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner