Provider Demographics
NPI:1275775520
Name:HEARD, AMANDA DAISY (MD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:DAISY
Last Name:HEARD
Suffix:
Gender:F
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:STONY BROOK MEDICINE DEPT OF EMERG MEDICINE
Mailing Address - Street 2:HSC, LEVEL 4, RM 080
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-8350
Mailing Address - Country:US
Mailing Address - Phone:631-444-2478
Mailing Address - Fax:631-444-6031
Practice Address - Street 1:STONY BROOK MEDICINE DEPT OF EMERG MEDICINE
Practice Address - Street 2:HSC, LEVEL 4, RM 080
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8350
Practice Address - Country:US
Practice Address - Phone:631-444-2478
Practice Address - Fax:631-444-6031
Is Sole Proprietor?:No
Enumeration Date:2009-04-01
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY264450207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program