Provider Demographics
NPI:1508521444
Name:GADDY, AMBER LASHEA (CPM)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:LASHEA
Last Name:GADDY
Suffix:
Gender:M
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8526 DONEGAL ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78254-2021
Mailing Address - Country:US
Mailing Address - Phone:210-315-4117
Mailing Address - Fax:
Practice Address - Street 1:8526 DONEGAL ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78254-2021
Practice Address - Country:US
Practice Address - Phone:210-315-4117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-04
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife