Provider Demographics
NPI:1134351539
Name:SCHUCK-PHAN, AMANDA T (DO)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:T
Last Name:SCHUCK-PHAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2018088
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77216-1088
Mailing Address - Country:US
Mailing Address - Phone:134-866-7607
Mailing Address - Fax:
Practice Address - Street 1:920 MEDICAL PLAZA DR STE 140
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77380-3751
Practice Address - Country:US
Practice Address - Phone:713-486-6760
Practice Address - Fax:713-486-6784
Is Sole Proprietor?:No
Enumeration Date:2009-08-18
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP0133208000000X, 2080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics