Provider Demographics
NPI:1962891424
Name:SENEA, AMANDA
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:SENEA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18282 69TH DR
Mailing Address - Street 2:
Mailing Address - City:MC ALPIN
Mailing Address - State:FL
Mailing Address - Zip Code:32062-2700
Mailing Address - Country:US
Mailing Address - Phone:386-249-1640
Mailing Address - Fax:386-364-1633
Practice Address - Street 1:18282 69TH DR
Practice Address - Street 2:
Practice Address - City:MC ALPIN
Practice Address - State:FL
Practice Address - Zip Code:32062-2700
Practice Address - Country:US
Practice Address - Phone:386-249-1640
Practice Address - Fax:386-364-1633
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-21
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCRC1329482171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006611200Medicaid