Provider Demographics
NPI:1851736086
Name:FENTON, AMY SARAH (PA)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:SARAH
Last Name:FENTON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 DISTEL CIR
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1408
Mailing Address - Country:US
Mailing Address - Phone:650-617-8100
Mailing Address - Fax:650-327-2947
Practice Address - Street 1:1950 UNIVERSITY AVENUE
Practice Address - Street 2:SUITE 160
Practice Address - City:E PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94303-2285
Practice Address - Country:US
Practice Address - Phone:650-617-8100
Practice Address - Fax:650-327-2947
Is Sole Proprietor?:No
Enumeration Date:2013-05-01
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA17871363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical