Provider Demographics
NPI:1689756595
Name:RYAN, AMANDA D (DO)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:D
Last Name:RYAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:D
Other - Last Name:RHODES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:2420 W PIERCE ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-3543
Mailing Address - Country:US
Mailing Address - Phone:575-234-1855
Mailing Address - Fax:575-234-2854
Practice Address - Street 1:2420 W PIERCE ST
Practice Address - Street 2:SUITE 100
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-3543
Practice Address - Country:US
Practice Address - Phone:575-234-1855
Practice Address - Fax:575-234-2854
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMA-1931-16207RI0011X
FLOC10503207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL78306OtherBCBS
FL000430500Medicaid