NPI 1003193202

Amanda Lyn Fidiam, PAC

Practitioner Medical Physician Assistant Moosic, PA

Practice location

Address: 340 Montage Mountain Rd, Moosic, PA 18507-1782
Phone: (570) 346-3686
Fax: (570) 558-6838

Registered specialties

Medical Physician Assistant Primary

Physician Assistants & Advanced Practice Nursing Providers Taxonomy 363AM0700X Licence MA055142 (PA)

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Registry record

NPI: 1003193202
Entity type: Individual
Sex (as registered): Female
NPI issued: 16 Nov 2011
Record last updated: 4 Sep 2014

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.