Provider Demographics
NPI:1134515737
Name:VALONE, AMANDA S (DO)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:S
Last Name:VALONE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:1616 CAMINO REDONDO
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMOS
Mailing Address - State:NM
Mailing Address - Zip Code:87544-2719
Mailing Address - Country:US
Mailing Address - Phone:505-661-1616
Mailing Address - Fax:
Practice Address - Street 1:1501 SAN PEDRO DR SE RM 145
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-5180
Practice Address - Country:US
Practice Address - Phone:505-690-7657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-09
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMA-2117-182084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry