Provider Demographics
NPI:1053185546
Name:STROUD, AMANDA CHARITY (CSFA)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:CHARITY
Last Name:STROUD
Suffix:
Gender:F
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4163 MARK N SMITH RD
Mailing Address - Street 2:
Mailing Address - City:DEEP RUN
Mailing Address - State:NC
Mailing Address - Zip Code:28525-9558
Mailing Address - Country:US
Mailing Address - Phone:252-560-9638
Mailing Address - Fax:
Practice Address - Street 1:2700 WAYNE MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-9494
Practice Address - Country:US
Practice Address - Phone:919-731-6065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-14
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant