Provider Demographics
NPI:1013288166
Name:ANANIA, AMANDA YUN (PA-C)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:YUN
Last Name:ANANIA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1380 E STROOP RD
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-4926
Mailing Address - Country:US
Mailing Address - Phone:937-294-4356
Mailing Address - Fax:937-297-2381
Practice Address - Street 1:3535 PENTAGON BLVD STE 330
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45431-1705
Practice Address - Country:US
Practice Address - Phone:937-757-9449
Practice Address - Fax:937-702-4944
Is Sole Proprietor?:No
Enumeration Date:2012-01-21
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL363A00000X
FLPA9106438363A00000X, 363AM0700X
OH50.005533RX363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0306837Medicaid
FL005470100Medicaid
FLPA9106438OtherMEDICAL LICENSE