Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Amanda Sue Poulos, PA

Individual provider Physician Assistant · NPI 1508377060

Amanda Sue Poulos, PA is a Physician Assistant in Philadelphia, Pennsylvania. Qualified in 2019, 7 years ago. Practices with Cooper Faculty Ob-Gyn, PC, a 41-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in New Jersey.

Years since qualifying
7
Licensed in
NJ
In the registry since
2017
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

1412 Fairmount Ave
Philadelphia, PA 19130-2908
Phone: (215) 235-9600
Fax: (215) 684-5360
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 3 Cooper Plz Rm 300, Camden, NJ 08103-1438 — (856) 342-2959

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 25MP00931200 (NJ)

Record details

NPI number1508377060
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA
Sole proprietorNo
NPI enumeratedOctober 23, 2017
Last updated in NPPESSeptember 9, 2025
Certification dateSeptember 9, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2019 (7 years in practice)
Group practice Cooper Faculty Ob-Gyn, Pc — 41 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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