Individual
AMANDA MARIE MASCARENAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC, CSCS
Contact information
Practice address
262 CRESTWOOD LN, RAEFORD, NC 28376-7828
(540) 220-8171
Mailing address
262 CRESTWOOD LN, RAEFORD, NC 28376-7828
(540) 220-8171
Taxonomy
Speciality
Code
Description
License number
State
2083S0010X
Sports Medicine (Preventive Medicine) Physician
Primary
LAT-4149
NC
Other
Enumeration date
04/18/2021
Last updated
04/18/2021
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