Individual
AMANDA ANASTASOFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
35640 WEST MICHIGAN AVENUE, WAYNE, MI 48184
(734) 729-7792
Mailing address
13316 IDA CENTER RD, IDA, MI 48140-9722
(734) 347-0712
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
—
Other
Enumeration date
09/01/2016
Last updated
09/01/2016
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