Provider Demographics
NPI:1376379636
Name:SYLVIA, AMANDA LEE (FNP-BC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LEE
Last Name:SYLVIA
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 1:119 COGGESHALL ST
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02746-2443
Mailing Address - Country:US
Mailing Address - Phone:508-990-1900
Mailing Address - Fax:
Practice Address - Street 1:119 COGGESHALL ST
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02746-2443
Practice Address - Country:US
Practice Address - Phone:508-990-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2303308363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily