Provider Demographics
NPI:1417547761
Name:MBI, AMANDA MAXINE ALYNDOH
Entity Type:Individual
Prefix:
First Name:AMANDA MAXINE
Middle Name:ALYNDOH
Last Name:MBI
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 1:2671 RAINY SPRING CT
Mailing Address - Street 2:
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-3304
Mailing Address - Country:US
Mailing Address - Phone:443-986-3253
Mailing Address - Fax:
Practice Address - Street 1:2671 RAINY SPRING CT
Practice Address - Street 2:
Practice Address - City:ODENTON
Practice Address - State:MD
Practice Address - Zip Code:21113-3304
Practice Address - Country:US
Practice Address - Phone:443-986-3253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical