Provider Demographics
NPI:1972809044
Name:BLISS, AMANDA KAYE (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:KAYE
Last Name:BLISS
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 FREDERICK HEALTH WAY
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-9435
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:194 THOMAS JOHNSON DR
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4679
Practice Address - Country:US
Practice Address - Phone:240-215-6310
Practice Address - Fax:240-566-7754
Is Sole Proprietor?:No
Enumeration Date:2011-02-07
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006528-1133VN1006X
NY014596-1363AM0700X
WV01753363AM0700X
MDC0007382363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic