Provider Demographics
NPI:1487063178
Name:AMANTEA, CRYSTAL VIMPENY (AU'D)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:VIMPENY
Last Name:AMANTEA
Suffix:
Gender:F
Credentials:AU'D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10200 THREE CHOPT RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23233-2083
Mailing Address - Country:US
Mailing Address - Phone:804-288-3277
Mailing Address - Fax:804-282-1043
Practice Address - Street 1:10200 THREE CHOPT RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23233-2083
Practice Address - Country:US
Practice Address - Phone:804-288-3277
Practice Address - Fax:804-282-1043
Is Sole Proprietor?:No
Enumeration Date:2014-08-06
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2201001521231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist