Individual
MRS. AMANDA RAE WHITESIDE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
14520 W GRANITE VALLEY DR STE 210, SUN CITY WEST, AZ 85375-5855
(866) 974-2673
(866) 939-2673
Mailing address
18444 N 25TH AVE STE 310, PHOENIX, AZ 85023-1266
(669) 742-6738
(866) 939-2673
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
7530
AZ
363AS0400X
Surgical Physician Assistant
Primary
7530
AZ
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
583027
—
AZ
Enumeration date
10/13/2018
Last updated
08/11/2025
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