Provider Demographics
NPI:1972185544
Name:SCOTT, AMANDA KAYLA
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:KAYLA
Last Name:SCOTT
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 1:231 SEASONS RD STE 300
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44224-1069
Mailing Address - Country:US
Mailing Address - Phone:330-662-5666
Mailing Address - Fax:330-928-6785
Practice Address - Street 1:231 SEASONS RD STE 300
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44224-1069
Practice Address - Country:US
Practice Address - Phone:330-662-5666
Practice Address - Fax:330-928-6785
Is Sole Proprietor?:No
Enumeration Date:2021-04-23
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH34.016823207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program