Provider Demographics
NPI:1831572940
Name:ANDERSON, AMANDA ROSE (PSYD)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:ROSE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7001 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-6719
Mailing Address - Country:US
Mailing Address - Phone:407-853-7700
Mailing Address - Fax:407-853-7739
Practice Address - Street 1:7001 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792
Practice Address - Country:US
Practice Address - Phone:407-853-7700
Practice Address - Fax:407-853-7739
Is Sole Proprietor?:No
Enumeration Date:2015-07-07
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY10162103T00000X, 103T00000X
NE952103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPY10162OtherPSYCHOLOGY LICENSE
NE47037660631Medicaid
NE10026172100Medicaid
NE10026412500Medicaid