Provider Demographics
NPI:1861236036
Name:JORDAN, AMANDA MAUREEN (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MAUREEN
Last Name:JORDAN
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:814 LIGHTHOUSE PT
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:14072-2267
Mailing Address - Country:US
Mailing Address - Phone:716-517-5436
Mailing Address - Fax:
Practice Address - Street 1:621 10TH ST
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14301-1813
Practice Address - Country:US
Practice Address - Phone:716-517-5436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-22
Last Update Date:2024-06-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY031114363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical