Provider Demographics
NPI:1548903321
Name:FRONDELLA, AMANDA (MD)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:
Last Name:FRONDELLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 LACKAWANNA AVE APT 302
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18503-2081
Mailing Address - Country:US
Mailing Address - Phone:416-576-6014
Mailing Address - Fax:
Practice Address - Street 1:12 LILY LAKE ROAD
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:PA
Practice Address - Zip Code:18471
Practice Address - Country:US
Practice Address - Phone:570-808-3700
Practice Address - Fax:570-808-3701
Is Sole Proprietor?:No
Enumeration Date:2022-04-19
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT235449207RA0401X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program