Provider Demographics
NPI:1962971564
Name:SCELFO, AMANDA ROSE (AGPCNP-BC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:ROSE
Last Name:SCELFO
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:741 NORTHFIELD AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-1104
Mailing Address - Country:US
Mailing Address - Phone:973-467-1544
Mailing Address - Fax:973-467-9586
Practice Address - Street 1:741 NORTHFIELD AVE STE 205
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-1104
Practice Address - Country:US
Practice Address - Phone:973-467-1544
Practice Address - Fax:973-467-9586
Is Sole Proprietor?:No
Enumeration Date:2018-11-13
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00878600363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner