Provider Demographics
NPI:1952630303
Name:AHDUT, AMIRA J (NMD)
Entity Type:Individual
Prefix:
First Name:AMIRA
Middle Name:J
Last Name:AHDUT
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15655 NORTHEAST 85TH STREET
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-3563
Mailing Address - Country:US
Mailing Address - Phone:425-881-3100
Mailing Address - Fax:
Practice Address - Street 1:15655 NORTHEAST 85TH STREET
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3563
Practice Address - Country:US
Practice Address - Phone:425-881-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-14
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ09-1148175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath