Provider Demographics
NPI:1841439049
Name:FREY, AMANDA JEANNE (DC)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:JEANNE
Last Name:FREY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MS
Other - First Name:AMANDA
Other - Middle Name:JEANNE
Other - Last Name:DE PRADA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6388 SILVER STAR RD
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32818-3235
Mailing Address - Country:US
Mailing Address - Phone:407-253-1114
Mailing Address - Fax:407-253-1180
Practice Address - Street 1:6388 SILVER STAR RD
Practice Address - Street 2:SUITE 2A
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32818-3235
Practice Address - Country:US
Practice Address - Phone:407-253-1114
Practice Address - Fax:407-253-1180
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-11
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9648111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor