Individual
AMANDA JUDITH STEVENSON-CALI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
905 VERDAE BLVD STE 101, GREENVILLE, SC 29607-4029
(864) 286-7550
(864) 286-7551
Mailing address
1 INDEPENDENCE PT STE 212, GREENVILLE, SC 29615-4536
(864) 797-6308
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1586
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1103PA
—
SC
01
—
AA61116067
MEDICARE PTAN
SC
01
—
AA61116067
MEDICARE PTAN
—
01
—
AA61116121
MEDICARE PTAN
SC
01
—
AA61118510
MEDICARE PIN
SC
01
—
AA61119068
MEDIARE PIN
SC
Enumeration date
03/06/2007
Last updated
12/29/2020
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