Provider Demographics
NPI:1811707433
Name:SACCO, AMANDA JULIA (RN)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:JULIA
Last Name:SACCO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 MARSHALL BRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-1247
Mailing Address - Country:US
Mailing Address - Phone:954-614-0080
Mailing Address - Fax:
Practice Address - Street 1:174 MARSHALL BRIDGE DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-1247
Practice Address - Country:US
Practice Address - Phone:954-614-0080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-08
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC276627163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse