Provider Demographics
NPI:1700268562
Name:MATTER, AMANDA DIONNE (PA-C)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:DIONNE
Last Name:MATTER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:DIONNE
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-9800
Mailing Address - Country:US
Mailing Address - Phone:717-242-0196
Mailing Address - Fax:717-242-0701
Practice Address - Street 1:224 N LOGAN BLVD
Practice Address - Street 2:
Practice Address - City:BURNHAM
Practice Address - State:PA
Practice Address - Zip Code:17009-1850
Practice Address - Country:US
Practice Address - Phone:717-242-0196
Practice Address - Fax:717-242-0701
Is Sole Proprietor?:No
Enumeration Date:2015-06-29
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA003552363A00000X
PAML3595608363A00000X
PAMA060453363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMA060453OtherPENNSYLVANIA LICENSING BOARD