Individual
AMANDA SUE POULOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1412 FAIRMOUNT AVE, PHILADELPHIA, PA 19130-2908
(215) 235-9600
(215) 684-5360
Mailing address
1 FEDERAL ST STE 200, CAMDEN, NJ 08103-1088
(848) 288-6935
(732) 790-0107
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
25MP00931200
NJ
Other
Enumeration date
10/23/2017
Last updated
09/09/2025
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