Individual
AMANDA SHER FALLOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3939 CENTRAL PIKE, HERMITAGE, TN 37076-3499
(615) 883-2331
(615) 391-1785
Mailing address
3024 BUSINESS PARK CIR, GOODLETTSVILLE, TN 37072-3132
(615) 239-2018
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
1758
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12328183
CAQH
—
05
—
1526983
—
TN
01
—
621798471
GROUP TAX ID
TN
Enumeration date
10/19/2009
Last updated
05/18/2023
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