Provider Demographics
NPI:1841832789
Name:BODY, AMANDA N
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:N
Last Name:BODY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 MERCER ST NW
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-2934
Mailing Address - Country:US
Mailing Address - Phone:321-508-8011
Mailing Address - Fax:
Practice Address - Street 1:411 MERCER ST NW
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-2934
Practice Address - Country:US
Practice Address - Phone:321-508-8011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-11
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant