Provider Demographics
NPI:1316345309
Name:ALLEN, AMANDA DELORES
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:DELORES
Last Name:ALLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2105B FAIRMOUNT AVE
Mailing Address - Street 2:APT B
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-5137
Mailing Address - Country:US
Mailing Address - Phone:252-366-3191
Mailing Address - Fax:252-399-1193
Practice Address - Street 1:204 KENMORE ST N
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-1848
Practice Address - Country:US
Practice Address - Phone:252-366-3191
Practice Address - Fax:252-399-1193
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-08
Last Update Date:2014-12-08
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment