Provider Demographics
NPI:1053094326
Name:AMANFO, DAMIAN CHUKWUNYERENDU
Entity type:Individual
Prefix:
First Name:DAMIAN
Middle Name:CHUKWUNYERENDU
Last Name:AMANFO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 LUNDBERG ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-5375
Mailing Address - Country:US
Mailing Address - Phone:978-328-6138
Mailing Address - Fax:
Practice Address - Street 1:226 FIELD ST
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-2133
Practice Address - Country:US
Practice Address - Phone:508-979-5557
Practice Address - Fax:508-979-5955
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-11
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2262235363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health