Provider Demographics
NPI:1154993210
Name:AHEARN, AMANDA MARIE (PA-C)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:MARIE
Last Name:AHEARN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 SLEEPY HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:BYRAM TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:07821-3323
Mailing Address - Country:US
Mailing Address - Phone:862-219-0920
Mailing Address - Fax:
Practice Address - Street 1:193 MOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-1755
Practice Address - Country:US
Practice Address - Phone:973-218-1579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-16
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant