Provider Demographics
NPI:1205276748
Name:ZEGLIS, AMANDA SUZANNE (DO)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:SUZANNE
Last Name:ZEGLIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:SUZANNE
Other - Last Name:FOSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:ONE HOSPITAL DRIVE, DC067.00
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65212
Mailing Address - Country:US
Mailing Address - Phone:573-882-8907
Mailing Address - Fax:573-884-1070
Practice Address - Street 1:ONE HOSPITAL DRIVE, DC067.00
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65212
Practice Address - Country:US
Practice Address - Phone:573-882-8907
Practice Address - Fax:573-884-1070
Is Sole Proprietor?:No
Enumeration Date:2013-06-28
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20130181882084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry