Provider Demographics
NPI:1447992300
Name:MELLENDICK, AMANDA MARIE
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARIE
Last Name:MELLENDICK
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 1:324 E CHERRY HILL RD
Mailing Address - Street 2:
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-3028
Mailing Address - Country:US
Mailing Address - Phone:443-244-2699
Mailing Address - Fax:
Practice Address - Street 1:1207 LIBERTY RD STE 106
Practice Address - Street 2:
Practice Address - City:ELDERSBURG
Practice Address - State:MD
Practice Address - Zip Code:21784-6574
Practice Address - Country:US
Practice Address - Phone:410-549-5700
Practice Address - Fax:410-549-6200
Is Sole Proprietor?:No
Enumeration Date:2022-04-11
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
MD29075225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist