Provider Information for 1922616887
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Ms. AMANDA GRANT SW 18293
Sex: Female
NPI: 1922616887
Last Updated: 2021-06-15
Certification Date: 2021-06-15
Certification Date: 2021-06-15
Details
Name | Value | ||||||||||||
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NPI | 1922616887 | ||||||||||||
Enumeration Date | 2020-07-16 | ||||||||||||
NPI Type | NPI-1 Individual | ||||||||||||
Sole Proprietor | YES | ||||||||||||
Status | Active | ||||||||||||
Mailing Address | 1890 NW 127TH ST MIAMI, FL 33167-2175 United States Phone: 786-319-7339 | Fax: | ||||||||||||
Primary Practice Address | 1890 NW 127TH ST MIAMI, FL 33167-2175 United States Phone: 786-319-7339 | Fax: | ||||||||||||
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