Provider Demographics
NPI:1790718062
Name:AMAYA, CELESTE L (MD)
Entity Type:Individual
Prefix:DR
First Name:CELESTE
Middle Name:L
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 1:1250 PINE RIDGE RD
Mailing Address - Street 2:STE 101A
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34108-8913
Mailing Address - Country:US
Mailing Address - Phone:760-406-1993
Mailing Address - Fax:239-261-9993
Practice Address - Street 1:1250 PINE RIDGE RD STE 101A
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34108-8913
Practice Address - Country:US
Practice Address - Phone:239-261-9990
Practice Address - Fax:239-261-9993
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA68073207R00000X
FLME149807207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A680730Medicaid
CABC713ZMedicare PIN
CA00A680730Medicaid
CAG92854Medicare UPIN