Provider Demographics
NPI:1336293646
Name:AMAYA, DAMARIS (PNP)
Entity Type:Individual
Prefix:
First Name:DAMARIS
Middle Name:
Last Name:AMAYA
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 S WASHINGTON SQ
Mailing Address - Street 2:APT 1718
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-4118
Mailing Address - Country:US
Mailing Address - Phone:305-299-0946
Mailing Address - Fax:305-299-0946
Practice Address - Street 1:34TH STREET AND CIVIC CENTER BLVD
Practice Address - Street 2:MAIN 1W39
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104
Practice Address - Country:US
Practice Address - Phone:215-590-3481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00126000363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics