Provider Demographics
NPI:1417442096
Name:AMAY, EMMANUEL
Entity Type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:
Last Name:AMAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:EMMANUEL
Other - Middle Name:
Other - Last Name:AMAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:TRANSPORTOR
Mailing Address - Street 1:12687 MT ANTERO DR
Mailing Address - Street 2:
Mailing Address - City:PEYTON
Mailing Address - State:CO
Mailing Address - Zip Code:80831-3823
Mailing Address - Country:US
Mailing Address - Phone:719-822-8484
Mailing Address - Fax:719-494-2088
Practice Address - Street 1:12687 MT ANTERO DR
Practice Address - Street 2:
Practice Address - City:PEYTON
Practice Address - State:CO
Practice Address - Zip Code:80831-3823
Practice Address - Country:US
Practice Address - Phone:719-822-8484
Practice Address - Fax:719-494-2088
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-26
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No385H00000XRespite Care FacilityRespite CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH83-0730400OtherIRS