Provider Demographics
NPI:1447548441
Name:HOFMANN, AMANDA RAE (PA-C)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:RAE
Last Name:HOFMANN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:RAE
Other - Last Name:CANDELMO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:453 VALLEY BROOK RD
Mailing Address - Street 2:
Mailing Address - City:CANONSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15317-3371
Mailing Address - Country:US
Mailing Address - Phone:724-544-0916
Mailing Address - Fax:
Practice Address - Street 1:453 VALLEY BROOK RD
Practice Address - Street 2:
Practice Address - City:CANONSBURG
Practice Address - State:PA
Practice Address - Zip Code:15317-3371
Practice Address - Country:US
Practice Address - Phone:724-544-0916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA054784363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical