Provider Demographics
NPI:1922085356
Name:AMATO, RENEE (PA)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:AMATO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:PO BOX 23340
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63156-3340
Mailing Address - Country:US
Mailing Address - Phone:314-849-6000
Mailing Address - Fax:314-849-1417
Practice Address - Street 1:12345 W BEND DR
Practice Address - Street 2:SUITE 300
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2182
Practice Address - Country:US
Practice Address - Phone:314-849-6000
Practice Address - Fax:314-849-1417
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2011-05-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2005033632363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOQ57214Medicare UPIN
MO000097273Medicare ID - Type UnspecifiedPROVIDER NUMBER
MO124510011Medicare PIN