Provider Demographics
NPI:1780798991
Name:STARRY, AMY M (DO)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:M
Last Name:STARRY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7541 W OAKLAND PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33319-4909
Mailing Address - Country:US
Mailing Address - Phone:954-459-4600
Mailing Address - Fax:954-459-3333
Practice Address - Street 1:7541 W OAKLAND PARK BLVD
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33319-4909
Practice Address - Country:US
Practice Address - Phone:954-459-4600
Practice Address - Fax:954-459-3333
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOA9171207XX0005X
FLOS8384207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
W17163OtherMEDICARE GROUP NUMBER
W17163OtherMEDICARE PTAN
I72770Medicare UPIN