Provider Demographics
NPI:1992231039
Name:MORAN, AMANDA P (DO)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:P
Last Name:MORAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:NORRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6275 E VIRGINIA BEACH BLVD STE 303
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-2851
Mailing Address - Country:US
Mailing Address - Phone:757-461-3141
Mailing Address - Fax:757-461-1658
Practice Address - Street 1:6275 E VIRGINIA BEACH BLVD STE 303
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-2851
Practice Address - Country:US
Practice Address - Phone:757-461-3141
Practice Address - Fax:757-461-1658
Is Sole Proprietor?:No
Enumeration Date:2017-05-10
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102205507208100000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation