Provider Demographics
NPI:1679033344
Name:SU, AMANDA EMMELINE (MD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:EMMELINE
Last Name:SU
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 1:5323 HARRY HINES BLVD CHILD AND ADOLESCENT PSYCHIATRY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75390-8589
Mailing Address - Country:US
Mailing Address - Phone:214-456-4586
Mailing Address - Fax:
Practice Address - Street 1:9400 N CENTRAL EXPY STE 1304
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-5047
Practice Address - Country:US
Practice Address - Phone:972-502-4190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-20
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY570042084P0800X
TXU85942084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry