1164447462 NPI number — MS. AMANDA Y SHEETS PA

Table of content: MS. AMANDA Y SHEETS PA (NPI 1164447462)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164447462 NPI number — MS. AMANDA Y SHEETS PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHEETS
Provider First Name:
AMANDA
Provider Middle Name:
Y
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164447462
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/03/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2950 HALCYON LN STE 706
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32223-6692
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-298-7811
Provider Business Mailing Address Fax Number:
904-913-0288

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2950 HALCYON LN STE 706
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32223-6692
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-298-7811
Provider Business Practice Location Address Fax Number:
904-913-0288
Provider Enumeration Date:
07/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  PA9103749 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2924951-00 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 743513332A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 113289300 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2026 www.npivalidator.com