Individual
MISS AMANDA M GALLOWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
1038-1050 MAIN ST, SPRINGFIELD, MA 01103
(413) 739-1100
Mailing address
1038-1050 MAIN STREET, SPRINGFIELD, MA 01103
(413) 739-1100
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
003131
CT
363A00000X
Physician Assistant
Primary
PA5130
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110028120
—
MA
01
—
MB0971780J
STATE CONTROLLED SUBSTANCE REGISTRATION
MA
Enumeration date
08/19/2014
Last updated
03/07/2023
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