Provider Demographics
NPI:1487902391
Name:PRESTON, AMANDA KAY (PA)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:KAY
Last Name:PRESTON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:KAY
Other - Last Name:PRESTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:384 SAIRS AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07740-5712
Mailing Address - Country:US
Mailing Address - Phone:732-804-3970
Mailing Address - Fax:
Practice Address - Street 1:1200 JUMPING BROOK RD
Practice Address - Street 2:
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-2634
Practice Address - Country:US
Practice Address - Phone:732-804-3970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-27
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant