Individual provider Active NPI

Amanda Wojewodka Canavan, PA-C

  • Physician Assistant
  • Newark, DE
National Provider Identifier
1154307759
Registry record updated Jan 23, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
C5-0001255 Issued in DE
Practice address
4755 Ogletown Stanton Rd Ste 2670
Newark, DE 19718-2200
Phone
(302) 733-2438
NPI assigned
Dec 16, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X C5-0001255 DE Primary
Medical Physician Assistant 363AM0700X MA054081 PA

Addresses

Primary practice location

4755 Ogletown Stanton Rd Ste 2670
Newark, DE 19718-2200

Mailing address

4755 Ogletown Stanton Rd Ste 2670
Newark, DE 19718-2200
Phone (302) 733-2438

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DE
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181121002422 DE Practitioner - Physician Assistant 6406877968 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
ENT and Allergy of Delaware LLCGroup PAC ID 2264613504, 42 clinicians

Practice addresses (Care Compare)

1401 Foulk Rd
Suite 205
Wilmington, DE 19803-2764
Phone (302) 998-0300

700 Prides Crossing
Suite 200
Newark, DE 19713-6109

700 Prides Xing
Suite 200
Newark, DE 19713-6109
Phone (302) 998-0300

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Christiana Care Health Services, Inc Physician Assistant CurrentSince Apr 16, 2022 Accepting new patients
Christiana Care Health Services Inc CurrentSince Nov 19, 2018 Accepting new patients
Christiana Care Health Services Inc CurrentSince Nov 19, 2018 Accepting new patients
Greengate Orthopaedic Group P.C. Past Accepting new patients
Christiana Care Health Services, Inc Physician Assistant Past Accepting new patients

Locations

4755 Ogletown Stanton Rd
Ste 5A43
Newark, DE 19718
Phone (302) 623-0188

4701 Ogletown Stanton Rd
Ste 1500
Newark, DE 19713
Phone (302) 623-4343

4755 Ogletown Stanton Rd
Ste 2670
Newark, DE 19718
Phone (302) 584-2601

1401 Foulk Rd
Ste 100B
Wilmington, DE 19803
Phone (302) 320-9440

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1134691200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548201600000",
    "number": "1154307759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4755 OGLETOWN STANTON RD STE 2670",
            "city": "NEWARK",
            "state": "DE",
            "postal_code": "197182200",
            "telephone_number": "302-733-2438"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4755 OGLETOWN STANTON RD STE 2670",
            "city": "NEWARK",
            "state": "DE",
            "postal_code": "197182200",
            "telephone_number": "302-733-2438"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CANAVAN",
        "first_name": "AMANDA",
        "middle_name": "WOJEWODKA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-16",
        "last_updated": "2019-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "DE",
            "license": "C5-0001255",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "PA",
            "license": "MA054081",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newark, DE

Sources for this page

Verify at the official NPI Registry.