Provider Demographics
NPI:1992102560
Name:WEBB, AMANDA JO (PA-C)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:JO
Last Name:WEBB
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:JO
Other - Last Name:SHUPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:380 W CHESTNUT ST STE 101
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-4658
Mailing Address - Country:US
Mailing Address - Phone:724-228-1414
Mailing Address - Fax:724-228-8579
Practice Address - Street 1:380 W CHESTNUT ST STE 101
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-4658
Practice Address - Country:US
Practice Address - Phone:724-228-1414
Practice Address - Fax:724-228-8579
Is Sole Proprietor?:No
Enumeration Date:2014-11-26
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA057384363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
14212085OtherCAQH