Provider Demographics
NPI:1851115554
Name:SOMEILLAN, AMANDA DOLORES (BA)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:DOLORES
Last Name:SOMEILLAN
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5113 LOUVRE AVE
Mailing Address - Street 2:
Mailing Address - City:BELLE ISLE
Mailing Address - State:FL
Mailing Address - Zip Code:32812-1029
Mailing Address - Country:US
Mailing Address - Phone:786-356-0021
Mailing Address - Fax:
Practice Address - Street 1:5113 LOUVRE AVE
Practice Address - Street 2:
Practice Address - City:BELLE ISLE
Practice Address - State:FL
Practice Address - Zip Code:32812-1029
Practice Address - Country:US
Practice Address - Phone:786-356-0021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management