Provider Demographics
NPI:1871829184
Name:DAMIRIS, AMANDA DAWN (PA-C)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:DAWN
Last Name:DAMIRIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6740 E CAMELBACK RD
Mailing Address - Street 2:SUITE #102
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-2096
Mailing Address - Country:US
Mailing Address - Phone:480-656-0291
Mailing Address - Fax:480-656-0127
Practice Address - Street 1:6740 E CAMELBACK RD
Practice Address - Street 2:SUITE #102
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-2096
Practice Address - Country:US
Practice Address - Phone:480-656-0291
Practice Address - Fax:480-656-0127
Is Sole Proprietor?:No
Enumeration Date:2009-10-21
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ4551363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant