Provider Demographics
NPI:1497754014
Name:WU, AMANDA MAN (MD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:MAN
Last Name:WU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:16308 TURNBURY OAK DR
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-2872
Mailing Address - Country:US
Mailing Address - Phone:813-814-9088
Mailing Address - Fax:813-814-9077
Practice Address - Street 1:4028 TAMPA RD
Practice Address - Street 2:
Practice Address - City:OLDSMAR
Practice Address - State:FL
Practice Address - Zip Code:34677-3205
Practice Address - Country:US
Practice Address - Phone:813-814-9088
Practice Address - Fax:813-814-9077
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-15
Last Update Date:2011-09-21
Deactivation Date:2006-03-18
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
FLME82723207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE6406Medicare ID - Type UnspecifiedPROVIDER #
FLH50024Medicare UPIN