Individual
MRS. AMANDA LYN FIDIAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
340 MONTAGE MOUNTAIN RD, MOOSIC, PA 18507-1782
(570) 346-3686
(570) 558-6838
Mailing address
340 MONTAGE MOUNTAIN RD, MOOSIC, PA 18507-1782
(570) 346-3686
(570) 558-6838
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
MA055142
PA
Other
Enumeration date
11/16/2011
Last updated
09/04/2014
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