Individual
AMANDA MARIE BLACKLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
9500 EUCLID AVE # G62, CLEVELAND, OH 44195-0001
(216) 444-4037
Mailing address
8900 STARLIGHT DR, MACEDONIA, OH 44056-1257
(440) 488-8797
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
50.005195RX
OH
Other
Enumeration date
09/20/2017
Last updated
09/20/2017
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