Provider Demographics
NPI:1518855238
Name:GULLO, AMANDA
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:GULLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 GALWAY DR APT 34
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94580-1260
Mailing Address - Country:US
Mailing Address - Phone:516-851-8034
Mailing Address - Fax:
Practice Address - Street 1:801 GALWAY DR APT 34
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:CA
Practice Address - Zip Code:94580-1260
Practice Address - Country:US
Practice Address - Phone:516-851-8034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-24
Last Update Date:2025-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach