Provider Demographics
NPI:1093457392
Name:ANDAYA, AMELITO MANUEL LOGRONIO (MD)
Entity Type:Individual
Prefix:MR
First Name:AMELITO MANUEL
Middle Name:LOGRONIO
Last Name:ANDAYA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1199 PRINCE AVE. #70
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606
Mailing Address - Country:US
Mailing Address - Phone:706-475-1826
Mailing Address - Fax:
Practice Address - Street 1:1270 PRINCE AVE.
Practice Address - Street 2:SUITE 102
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606
Practice Address - Country:US
Practice Address - Phone:706-475-7055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-08
Last Update Date:2023-02-23
Deactivation Date:2023-01-03
Deactivation Code:
Reactivation Date:2023-02-23
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program