Provider Demographics
NPI:1376947648
Name:AMADEO, MICHAEL ANTHONY (NP)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ANTHONY
Last Name:AMADEO
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1524
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91077-1524
Mailing Address - Country:US
Mailing Address - Phone:626-447-0296
Mailing Address - Fax:626-447-6057
Practice Address - Street 1:4077 5TH AVE
Practice Address - Street 2:EMS
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2105
Practice Address - Country:US
Practice Address - Phone:626-447-0296
Practice Address - Fax:626-623-1227
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-15
Last Update Date:2023-10-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA95001539363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily