Provider Demographics
NPI:1821003724
Name:YANCY, AMANDA FERN (MD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:FERN
Last Name:YANCY
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 1:28500 ORCHARD LAKE RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-2936
Mailing Address - Country:US
Mailing Address - Phone:248-539-0742
Mailing Address - Fax:248-538-5410
Practice Address - Street 1:28500 ORCHARD LAKE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-2936
Practice Address - Country:US
Practice Address - Phone:248-539-0742
Practice Address - Fax:248-538-5410
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301074417207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4622072Medicaid
MI4622072Medicaid
MIH94080Medicare UPIN