Individual
AMANDA CHRISTINE EVANGELISTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2119 SE DESTIN DR, PORT SAINT LUCIE, FL 34952-8000
(609) 402-5496
Mailing address
2119 SE DESTIN DR, PORT SAINT LUCIE, FL 34952-8000
(609) 402-5496
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
—
224Z00000X
Occupational Therapy Assistant
Primary
OTA19374
FL
Other
Enumeration date
10/06/2020
Last updated
03/29/2023
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