Provider Demographics
NPI:1417903428
Name:AMAYA, ZEDA G (MD)
Entity Type:Individual
Prefix:
First Name:ZEDA
Middle Name:G
Last Name:AMAYA
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:PO BOX 99371
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76199-0371
Mailing Address - Country:US
Mailing Address - Phone:685-885-1855
Mailing Address - Fax:682-885-7347
Practice Address - Street 1:2755 MILLER AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76105-4164
Practice Address - Country:US
Practice Address - Phone:817-534-7110
Practice Address - Fax:817-413-0521
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2014-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48390208000000X
TXN5530208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A483900Medicaid
TX217365002Medicaid
TX217365001Medicaid
TX217365001Medicaid