Provider Demographics
NPI:1023782224
Name:GREENFIELD, AMANDA MASAKO
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MASAKO
Last Name:GREENFIELD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3540 OLD GEORGETOWNE RD
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-0805
Mailing Address - Country:US
Mailing Address - Phone:405-513-3970
Mailing Address - Fax:
Practice Address - Street 1:3000 UNITED FOUNDERS BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-3958
Practice Address - Country:US
Practice Address - Phone:405-840-7040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-03
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist