Sally Gantt Amaya, PA-C
Individual provider Active NPI Physician Assistant · Daphne, AL
NPI 1568091379 · NPPES record last updated Jan 10, 2022
Key facts
- NPI
- 1568091379
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 1550 (AL)
- Practice address
- 28490 2ND St Ste B
Daphne, AL 36526-7150 - Phone
- (251) 308-9800
- NPI assigned
- Apr 3, 2020
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 7
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2019
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Dynamic Pain and Wellness LLC
Practice addresses (Care Compare)
1924 K Dauphin Island Pkwy
Mobile, AL 36605-3004
Phone (251) 308-9800
930 Mar Walt Dr
Fort Walton Beach, FL 32547-6706
Phone (850) 226-6801
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in AL, FL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200420000608 | AL | Practitioner - Physician Assistant | 6709216526 | Reassigns benefits to 1 organization |
| I20240814005018 | FL | Practitioner - Physician Assistant | 6709216526 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1550 | AL | MD | Physician Assistant |
| PA1550 | AL | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dynamic Pain & Wellness LLC | Current |
Accepting new patients | |
| Anesthesia Health Consultants | Current |
Accepting new patients |
Locations
28490 2nd St
Ste B
Daphne, AL 36526
Phone (251) 308-9800
1924K Dauphin Island Pkwy
Mobile, AL 36605
Phone (251) 308-9800
210 S Main St
Crestview, FL 32536
Phone (850) 306-3433
930 Mar Walt Dr
Unit C
Fort Walton Beach, FL 32547
Phone (850) 431-6183
930 Mar Walt Dr
Fort Walton Beach, FL 32547
Phone (850) 331-2930
5111 N 12th Ave
Pensacola, FL 32504
Phone (850) 291-7641
Interoperability endpoints
- sally.gantt@2498.securemail.prognocis.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA1550 | AL | |
| Physician Assistant | 363A00000X | 1550 | AL | Yes |
Addresses
Primary practice location
28490 2ND St Ste B
Daphne, AL 36526-7150
Mailing address
PO Box 7418
Spanish Fort, AL 36577-7418
Phone (251) 895-7133
Other names
- Sally Hale Gantt
Other providers in Daphne, AL
- Alabama Orthopaedic Clinic, PC
- Alabama Orthopaedic Sports Medicine LLC
- Allgood Dentistry, P.C.
- Katherine Marie Alsip
- Altapointe Health Systems Inc
- American Autism & Rehabilitation Center Inc
- American Family Care, LLC
- American Hyperbaric Center
- Aml Media LLC
- Jocelyn E Amoo
All providers in Daphne, AL · Physician Assistant in Alabama
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 10, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.