Provider Demographics
NPI:1104507276
Name:BURNS, AMANDA MICHELLE (CAP 100304)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:MICHELLE
Last Name:BURNS
Suffix:
Gender:F
Credentials:CAP 100304
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4043 TWINBUSH TER
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34286-7669
Mailing Address - Country:US
Mailing Address - Phone:941-356-7488
Mailing Address - Fax:
Practice Address - Street 1:6000 DEACON PL
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34238-2719
Practice Address - Country:US
Practice Address - Phone:888-330-2532
Practice Address - Fax:941-283-7550
Is Sole Proprietor?:No
Enumeration Date:2023-07-31
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLICADC.0000088101YA0400X
FLCAP0100304101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)