Provider Demographics
NPI:1528456787
Name:GANZAK, AMANDA (MS)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:GANZAK
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:BRANDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:330 ORCHARD ST STE 107
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-4430
Mailing Address - Country:US
Mailing Address - Phone:203-200-4362
Mailing Address - Fax:203-200-1362
Practice Address - Street 1:330 ORCHARD ST STE 107
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-4430
Practice Address - Country:US
Practice Address - Phone:032-200-4362
Practice Address - Fax:203-200-1362
Is Sole Proprietor?:No
Enumeration Date:2014-12-22
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAGC000151170300000X
CT157170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS