Provider Demographics
NPI:1215254800
Name:MANCUSO, AMANDA (PA)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:
Last Name:MANCUSO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:GILARSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2580 HAYMAKER RD STE 201
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-3500
Mailing Address - Country:US
Mailing Address - Phone:412-856-7500
Mailing Address - Fax:412-856-6079
Practice Address - Street 1:2580 HAYMAKER RD STE 201
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-3500
Practice Address - Country:US
Practice Address - Phone:412-856-7500
Practice Address - Fax:412-856-6079
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2023-10-31
Deactivation Date:2010-03-12
Deactivation Code:
Reactivation Date:2010-04-23
Provider Licenses
StateLicense IDTaxonomies
PAMA052420363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant