Provider Demographics
NPI:1366240459
Name:MIRANDA, AMANDA RAE
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:RAE
Last Name:MIRANDA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:RAE
Other - Last Name:BERGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:862 E SCHUYLKILL RD APT 128
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19465-1220
Mailing Address - Country:US
Mailing Address - Phone:732-552-6875
Mailing Address - Fax:
Practice Address - Street 1:1019 EGYPT RD UNIT 2B
Practice Address - Street 2:
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460-1111
Practice Address - Country:US
Practice Address - Phone:484-214-5550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-04
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL016636235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist