Provider Demographics
NPI:1417219197
Name:GACCETTA, AMANDA J (DO)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:J
Last Name:GACCETTA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 LONE STAR RD
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-8744
Mailing Address - Country:US
Mailing Address - Phone:682-341-5000
Mailing Address - Fax:
Practice Address - Street 1:2300 LONE STAR RD
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-8744
Practice Address - Country:US
Practice Address - Phone:682-341-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-08
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI62580-21207V00000X
390200000X
TXR2854207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIVAD000Medicare UPIN