Provider Demographics
NPI:1407480460
Name:WHEELER, AMANDA JOY
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:JOY
Last Name:WHEELER
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 1:3626 BELLE AVE NE
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24012-6408
Mailing Address - Country:US
Mailing Address - Phone:540-968-3030
Mailing Address - Fax:
Practice Address - Street 1:3626 BELLE AVE NE
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24012-6408
Practice Address - Country:US
Practice Address - Phone:540-968-3030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-28
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant