Provider Demographics
NPI:1033758792
Name:GALYEN, AMY E
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:E
Last Name:GALYEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7593 BLACKBERRY FARM RD
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-2107
Mailing Address - Country:US
Mailing Address - Phone:901-308-0359
Mailing Address - Fax:
Practice Address - Street 1:5565 MURRAY AVE STE 101
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-3828
Practice Address - Country:US
Practice Address - Phone:901-767-8152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-29
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2060124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist